Measuring consumer preference for models of diabetes care delivered by pharmacists

Main Article Content

Susan Taylor
Fleur Hourihan
Ines Krass
Carol L. Armour


Patient Satisfaction, Community Pharmacy Services, Cost-Benefit Analysis, Australia


Evaluation of a community pharmacy disease management program for type 2 diabetes, ‘SugarCare’, was conducted. Compared with the standard care offered by pharmacists, this enhanced program offered patients closer monitoring of blood glucose levels, counselling about lifestyle, etc. The SugarCare study was funded by a grant but if the care is to continue some other method of financing must be found.

Objectives: This study aimed to measure consumer preference for one of the two types of care offered in the SugarCare study, the control/standard and the intervention/enhanced service; the strength of that preference; and participants’ willingness to pay (WTP) for their preferred care.

Methods: SugarCare was a parallel groups, control versus intervention, repeated measures design conducted in three areas of NSW, Australia. Patients in the Intervention group (enhanced care) had one initial visit to the pharmacy with six follow up visits over approximately 9 months. At these visits blood glucose was downloaded and patient care issues addressed. At the end of the service, a survey instrument was mailed to the intervention and control participants who were asked to read it and then expect a telephone call within 2 weeks of receipt. Responses were requested over the phone and the survey instrument completed by the researcher. WTP data were collected using a modified payment card method.

Results: Overall, 44/75 (59%; 47%-70% 95%CI) respondents expressed a preference for Scenario B (the enhanced care) while 31/75 (41%; 31%-52% 95%CI) preferred Scenario A (standard care) however, the difference was not statistically significant. The median maximum WTP was AUD10 for the enhanced care and AUD3.50 for the standard care (p<0.03).

Conclusions: While the WTP values expressed were significantly higher for the enhanced care they did not match with the cost providing that diabetes care. Discrete choice analysis has the potential to overcome some of the difficulties encountered with the contingent valuation technique used here. Further research is required before WTP values such as these could be used with confidence to determine funding policy.

Abstract 1163 | PDF Downloads 623


1. Amos A, Zimmet P, McCarty D. The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabet Med. 1997;14:S7-S85.

2. Sczupak CA, Conrad WF. Relationship between patient-oriented pharmaceutical types of care and therapeutic outcomes of ambulatory patients with diabetes mellitus. Am J Hosp Pharm. 1977;34:1238-1242.

3. Jaber LA, Halapy H, Fernet M, Tummalapalli S, Diwakaran H. Evaluation of a pharmaceutical care model on diabetes management. Ann Pharmacother. 1996;30:238-243.

4. Berringer R, Shibley MC, Cary CC, Pugh CB, Powers PA, Rafi JA. Outcomes of a community pharmacy-based diabetes monitoring program. J Am Pharm Assoc. 1999; 39(6):791-797.

5. Davidson MB, Karlan VJ, Hair TL. Effect of a pharmacist-managed diabetes-care program in a free medical clinic. Am J Med Qual 2000;15(4):137-142.

6. Armour C, Taylor S, Hourihan F, Smith C, Krass I. Pharmacists leading the way in diabetes care- disease state management. J Am Pharm Assoc.2004; 44(4):455-466.

7. Simeons S. Economic evaluation of pharmacy practice: research informing policy. Int J Pharm Pract. 2008;16:337-338.

8. Scott A, Bond C, Inch J, Grant A. Preferences of community pharmacists for extended roles in primary care. Pharmacoeconomics. 2007; 25(9):783-792.

9. Taylor SJ, Milanova T, Hourihan F, Coleman C, Krass I, Armour CL. A cost effectiveness analysis of a community pharmacist-initiated disease state management care for type 2 diabetes mellitus. Int J Pharm Pract. 2005;13:33-40.

10. Hall J, Shiell A. What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Soc Sci Med. 1988;27: 935-939.

11. Ryan M, Scott DA, Bate A, van Teijlingen E, Russell EM, Napper M, Reeves C and Robb C. Eliciting public preferences for health care: a systematic review and evaluation of methods. Health Technol Assess. 2001;5(5):1-186.

12. Donaldson, C. Willingness to pay for publicly provided health care. University of Aberdeen, Scotland, 1995.

13. Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ. 1986;5(1):1-30.

14. Drummond MF, O'Brien B, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press, 1997.

15. Kroes EP, Sheldon RJ. Stated Preference Methods. J Transport Econ Policy 1988;(January):11-25.

16. Viscusi W. Labour market valuations of life and limb: empirical estimates and policy implications. Public Policy. 1978;26:359-389.

17. Ryan M. Using Consumer Preferences in health care decision making. Office of Health Economics, 1996.

18. Ryan M, Hughes J. Using conjoint analysis to assess women's preferences for miscarriage management. Health Econ. 1997;6:261-273.

19. Gafni A. Willingness To Pay - What's in a name? Pharmacoeconomics. 1998;14:465-470.

20. Diener A, O'Brien B, Gafni A. Health care contingent valuation studies: a review and classification of the literature. Health Econ., 1998;7:313-326.

21. Olsen JA, Smith RD. Theory versus practice: a review of “willingness to pay” in health and health care. Health Econ. 2001;10:39-52.

22. Klose T. The contingent valuation method in health care. Health Policy 1999;47(2):97-123.

23. Donaldson C, Shackley P, Abdalla M. Using willingness to pay to value close substitutes: carrier screening for cystic fibrosis revisited. Health Econ. 1997;6:145-159.

24. Ryan M. A role for conjoint analysis in technology assessment in health care? Int J Technol Assess Health Care. 1999;15:443-457.

25. Cookson R. Willingness to pay methods in health care: a skeptical view. Health Econ. 2003;12:891-894.

26. Johannesson M, Jonsson B. Economic evaluation in health care: is there a role for cost benefit analysis? Health Policy. 1991;17:1-23.

27. Gates B, Smith C, Krass I, Armour CL. Diabetes care in community pharmacy- a focus on training the pharmacist to deliver a specialised care. Aust J Pharm. 2001;82:504-508.

28. O’Brien B, Gafni A. When do the dollars make sense? Med Decis Mak 1996;16:288-299.

29. Taylor SJ, Armour CL. Measurement of consumer preference for treatments used to induce labour: a willingness-to-pay approach. Health Expect. 2000;3:203-216.

30. Ryan M, Gerard K, Amaya-Amaya M. Using Discrete Choice Experiments to Value Health and Health Care. Springer Berlin Heidelberg New York Ed 2008.

31. Payne K, Elliott R. Using discrete choice experiments to value preferences for pharmacy services. Int J Pharm Pract. 2005;13:9-20.

32. Ryan M. Discrete Choice Experiments in health care. BMJ. 2004;328:60-61.

33. Ryan M. Gerard K Using discrete choice experiments to value health care: current practice and future prospects. Appl Health Econ and Policy Anal. 2003;2:55-64.

34. Porteous T, Ryan M, Bond C, Hannaford P. Preferences for self-care or consulting a health professional for minor illness: A discrete choice experiment. Br J Gen Pract. 2006;56:911-917.

35. Gerard K, Salisbury C, D Street, Pope C, H Baxter. Is Fast Access to General Practice All That Should Matter? A Discrete Choice Experiment of Patients’ Preferences. J Health Serv Res Pol. 2008;13:3-10.

36. Taylor SJ, Armour CL. Consumer preference for dinoprostone vaginal gel using stated preference discrete choice modeling. Pharmacoeconomics. 2003; 21:721-735.

Most read articles by the same author(s)