PATIENT PREFERENCES FOR CHOLESTEROL TREATMENT OPTIONS: A DISCRETE CHOICE EXPERIMENT (DCE)

OBJECTIVES: With the recent approval of PCSK9 inhibitors, patients with cardiovascular disease (CVD) and their clinicians face a choice between a statin and this potentially more effective but very costly medication class. We conducted a DCE to understand what trade-offs patients are willing to make among the benefits, risks, and costs of these two medication classes. METHODS: We selected a sample of patients with self-reported CVD from an online national panel. Respondents completed a web-based questionnaire that presented a hypothetical clinical scenario and 12 choice questions, each containing 2 treatment options. Patients were asked to select their preferred treatment by comparing their attributes. Using conditional logistic regression, we estimated relative preferences, maximum acceptable risk, and willingness to pay. RESULTS: Among the 689 patients who met inclusion criteria, 521 (76%) completed the questionnaire. The average age was 62 years. The odds of choosing a drug requiring an injection every two weeks compared to a daily pill was 0.57 (95% CI 0.54-0.61). In order to accept the need to inject, patients would expect a 17% reduced risk of non-fatal CVD events, 11% reduced risk of fatal CVD events, 60% reduced risk of muscle symptoms, or 16% reduced risk of memory loss over a 10-year period. Patients on average were willing to pay $51/month out of pocket, or to have their insurance pay up to $1670/month for a daily pill rather than a bimonthly injection. CONCLUSIONS: With all other attributes being equal, monthly treatment cost and the need for injection were major drivers of patient preferences for choice of treatment. The smaller positive impact of expected benefits of PCSK9 inhibitors compared to statins in terms of reducing risk of CVD events are unlikely to offset these negative impacts on patient preferences unless outcome studies demonstrate significantly higher benefit than currently anticipated.