Quantifying the Utility of Taking Pills for Cardiovascular Prevention

Abstract

Background-The decrease in utility attributed to taking pills for cardiovascular prevention can have major effects on the cost-effectiveness of interventions but has not been well studied. We sought to measure the utility of daily pill-taking for cardiovascular prevention. Methods and Results-We conducted a cross-sectional Internet-based survey of 1000 US residents aged ≥30 in March 2014. We calculated utility values, using time trade-off as our primary method and standard gamble and willingnessto-pay techniques as secondary analyses. Mean age of respondents was 50 years. Most were female (59%) and white (63%); 28% had less than a college degree; and 79% took ≥1 pills daily. Mean utility using the time trade-off method was 0.990 (95% confidence interval, 0.988-0.992), including ≈70% not willing to trade any amount of time to avoid taking a preventive pill daily. Using the standard gamble method, mean utility was 0.991 (0.989-0.993), with 62% not willing to risk any chance of death. Respondents were willing to pay an average of $1445 to avoid taking a pill daily, which translated to a mean utility of 0.994 (0.940-0.997), including 41% unwilling to pay any amount. Time trade-off-based utility varied by age (decreasing utility as age increased), sex, race, numeracy, difficulty with obtaining pills, and number of pills taken per day but did not vary by education level, literacy, or income. Conclusions-Mean

Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling

“…This is consistent with the current methods of eliciting DTDs, which often use time-trade-off exercises (with questions spanning different hypothetical time periods, typically 10 years) to estimate the utility decrement to use for each 1-year time period. 185,[194][195][196] …”

Do Pills Have No Ills? Capturing the Impact of Direct Treatment Disutility

“…Three published empirical studies that relate to the concept of DTD were identified through the search strategy [6,8,9]; and one was found via reference list searching [10]. Gage et al find a disutility directly associated with taking warfarin of 0.003 and no disutility associated with taking aspirin when using a time-trade off method in patients (n=70) with atrial fibrillation [10].…”

“…Gage et al find a disutility directly associated with taking warfarin of 0.003 and no disutility associated with taking aspirin when using a time-trade off method in patients (n=70) with atrial fibrillation [10]. More recently, using time trade off (TTO) methods to elicit values, Hutchins et al found DTDs of 0.01 (95% CI: 0.008 to 0.013) in US residents (n=1000) and 0.003 (95% CI: 0.002 to 0.004) in US healthcare employees (n=708) for a scenario involving one pill per day for life which had no costs or side effects [8,9]. In both papers, standard gamble and willingness to pay methods were also used to elicit disutilities and gave comparable results.…”

Overhauling Cardiovascular Risk Prediction in Primary Prevention

“…Recent evidence suggests that patients are likely to decline statin treatment, even if it may potentially add years to their lives. 3 In fact, 21% of adults considering would pay $1000 or more for information to avoid taking a pill each day for the rest of their lives. 3 These concerns are emphatically countered by arguments that these thresholds do not mandate a statin prescription rather specifically calls for clinician-patient discussion.…”

“…3 In fact, 21% of adults considering would pay $1000 or more for information to avoid taking a pill each day for the rest of their lives. 3 These concerns are emphatically countered by arguments that these thresholds do not mandate a statin prescription rather specifically calls for clinician-patient discussion. However, I respectfully question, are we putting too much onus on patients to deal with these uncertain risk estimates, without arming them with tools to facilitate better informed decisions?…”