Holistic versus composite preferences for lifetime treatment sequences fortype 2 diabetes

This study of patient preferences for lifetime treatment sequences for type 2 diabetes had three objectives: to assess the feasibility of obtaining ho listic preference assessments using the time-tradeoff (TTO) technique; to c ompare composite and holistic preference scores for the same lifetime treat ment paths; and to assess the validity of composite and holistic preference measures in terms of their congruence with an individual's rank-order pref erences. 101 persons with type 2 diabetes provided preference ratings for h yperglycemic treatments lasting 30 years, including eight discrete treatmen t states and four treatment paths. Scenarios described drug and glucose-tes ting regimens, efficacy of glucose control, and side effects. After ranking and rating scenarios on a thermometer scare, subjects provided TTO prefere nces for each treatment state or path scenario. Holistic assessment of trea tment paths was feasible with the TTO technique, in terms of useable data ( 88% of interviews) and effect on coefficients of variation. Holistic and co mposite preference scores were not statistically different. Agreement was p oor between rankings implied by holistic and composite scores and direct ra nkings. The authors conclude that lifetime treatment paths with minor diffe rences in health effects can be assessed using either composite (QALY) or h olistic (HYE) measures. The validity of these TTO-based preference measures remains unknown.