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Diminishing marginal disutility of hypoglycaemic events: results from a time trade-off survey in five countries

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Abstract

Introduction

The negative impact of hypoglycaemic events on health-related quality of life (HRQoL) may be evaluated by attaching published disutilities to these events. It is suggested that the marginal negative impact of individual hypoglycaemic events on HRQoL may decrease as the overall frequency increases.

Methods

Using disutility values from a large-scale (>8,000 respondents), time trade-off (TTO) study, nonlinear regression curves were fitted to the total disutility of different frequencies of non-severe daytime and nocturnal hypoglycaemic events. Nonparametric bootstrapping was applied to characterise the uncertainty of the marginal disutility.

Results

Power function regression curves were estimated at U d = 0.0141x 0.3393 and U d = 0.0221x 0.3277. An increase from 0 to 1 hypoglycaemic event per year produced a utility decrease of 0.0141 and 0.0221 for non-severe daytime and nocturnal events, respectively. An increase from 25 to 26 events per year produced a marginal impact of 0.0006 and 0.0008 for non-severe daytime and nocturnal events, respectively.

Discussion

These data concur with the noted phenomenon of “first being worst” as regards hypoglycaemic events. This finding may reflect a coping mechanism on the part of patients, a maximum limit for trading off remaining lifetime or the nature of the study.

Conclusion

Applying nonlinear functions to the TTO data might improve the precision of the measured impact of hypoglycaemic events.

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Fig. 1
Fig. 2

Abbreviations

TTO:

Time trade-off

HRQoL:

Health-related quality of life

QALY:

Quality-adjusted life years

MID:

Minimally reported difference

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Acknowledgments

This study was sponsored by Novo Nordisk A/S. The study sponsors were involved in the study design and analysis of data, and provided a factual check of the manuscript during preparation. The authors wish to acknowledge Claire Passmore and Mark Nelson from Watermeadow Medical, UK for editorial support in the preparation of this manuscript and submission support, respectively.

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Authors and Affiliations

  1. Centre of Health Economics Research (COHERE), Campusvej 55, 5230, Odense M, Denmark

    Jørgen T. Lauridsen

  2. Incentive, Holte Stationsvej 14, 1, 2840, Holte, Denmark

    Jonas Lønborg & Henrik Holm Jensen

  3. Novo Nordisk A/S, Vandtårnsvej 114, 2860, Søborg, Denmark

    Jens Gundgaard

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  1. Jørgen T. Lauridsen
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  2. Jonas Lønborg
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Correspondence to Jørgen T. Lauridsen.

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Lauridsen, J.T., Lønborg, J., Gundgaard, J. et al. Diminishing marginal disutility of hypoglycaemic events: results from a time trade-off survey in five countries. Qual Life Res 23, 2645–2650 (2014). https://doi.org/10.1007/s11136-014-0712-x

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