Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility.
BACKGROUND
Primary prevention guidelines focus on risk, often assuming negligible aversion to medication, yet most patients discontinue primary prevention statins within 3 years. We quantify real-world distribution of medication disutility and separately calculate the average utilities for a range of risk strata.


METHOD AND RESULTS
We randomly sampled 360 members of the general public in London. Medication aversion was quantified as the gain in lifespan required by each individual to offset the inconvenience (disutility) of taking an idealized daily preventative tablet. In parallel, we constructed tables of expected gain in lifespan (utility) from initiating statin therapy for each age group, sex, and cardiovascular risk profile in the population. This allowed comparison of the widths of the distributions of medication disutility and of group-average expectation of longevity gain. Observed medication disutility ranged from 1 day to >10 years of life being required by subjects (median, 6 months; interquartile range, 1-36 months) to make daily preventative therapy worthwhile. Average expected longevity benefit from statins at ages ≥50 years ranges from 3.6 months (low-risk women) to 24.3 months (high-risk men).


CONCLUSION
We can no longer assume that medication disutility is almost zero. Over one-quarter of subjects had disutility exceeding the group-average longevity gain from statins expected even for the highest-risk (ie, highest-gain) group. Future primary prevention studies might explore medication disutility in larger populations. Patients may differ more in disutility than in prospectively definable utility (which provides only group-average estimates). Consultations could be enriched by assessing disutility and exploring its reasons.
['Fontana|Marianna|M|', 'Asaria|Perviz|P|', 'Moraldo|Michela|M|', 'Finegold|Judith|J|', 'Hassanally|Khalil|K|', 'Manisty|Charlotte H|CH|', 'Francis|Darrel P|DP|']
D000328:Adult D001794:Blood Pressure D002318:Cardiovascular Diseases D002784:Cholesterol D003657:Decision Making D005260:Female D006306:Health Surveys D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D008131:London D008136:Longevity D008297:Male D055118:Medication Adherence D008875:Middle Aged D010358:Patient Participation D015995:Prevalence D011322:Primary Prevention D018570:Risk Assessment D012307:Risk Factors D012907:Smoking D011795:Surveys and Questionnaires D055815:Young Adult
primary prevention compliance hydroxymethylglutaryl-CoA reductase inhibitors