Reduce mortality risk above all else: a discrete-choice experiment in acute coronary syndrome patients
Axel C Mühlbacher1, Susanne Bethge
1IGM Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany, muehlbacher@hs-nb.de.
Insights
Patients with acute coronary syndrome (ACS) prioritize reducing mortality risk above all else when choosing antiplatelet medications. Understanding these patient preferences is key for developing effective, patient-centered cardiovascular treatments.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Patient Preference Research
Background:
- Cardiovascular disease is a leading cause of death in industrialized nations.
- Limited understanding exists regarding patient valuation of treatment aspects for acute coronary syndrome (ACS).
- Evaluating patient preferences for antiplatelet medications post-ACS is crucial for improving care.
Purpose of the Study:
- To assess patient preferences for various attributes of antiplatelet medication options following an acute coronary syndrome (ACS).
- To inform patient-centered care strategies and the development of effective post-ACS therapies.
Main Methods:
- A discrete-choice experiment (DCE) was employed, incorporating patient-relevant treatment attributes identified through literature review and qualitative interviews.
- A forced-choice approach was used, with data analyzed via a random-effects logit model.
- Generalized linear latent and mixed models (GLLAMM) were utilized to explore subgroup differences.
Main Results:
- Mortality risk was the most highly valued attribute by ACS patients (coefficient: 0.803).
- Other significant preferences included reduced risk of dyspnea (0.550), new myocardial infarction (0.464), and bleeding (0.400).
- Frequency of intake was a less significant factor (0.025), while marital status, education level, and BMI influenced preference classes.
Conclusions:
- Mortality risk is the paramount concern for patients undergoing treatment for acute coronary syndrome (ACS).
- Incorporating patient preferences into decision-making is essential for patient-centered care.
- This research provides valuable data for healthcare decision-makers to enhance patient benefit through tailored therapies.
Background And Objective:
Cardiovascular disease is the main cause of death in Germany and other industrialized countries. However, until now, little has been known about how people with acute coronary syndrome (ACS) value aspects of their medical treatment. The objective of this study was to evaluate patients' preferences regarding different antiplatelet medication options following an ACS.
Method:
After identification of patient-relevant treatment attributes (a literature review and qualitative interviews), a discrete-choice experiment (DCE) including five patient-relevant attributes was conducted. The DCE used a forced-choice approach in which no "opt out" was present, as no treatment is not an option after ACS. The attribute and level combinations were created using a fractional-factorial NGene design with priors. Data analysis was performed using a random-effects logit model. An additional generalized linear latent and mixed models (GLLAMM) analysis was performed to evaluate subgroup differences.
Results:
ACS patients (N = 683) participated in computer-assisted personal interviews. Preference analysis showed a clear dominance of the attribute "mortality risk" (coefficient: 0.803). Ranked second was "side effect: dyspnea" (coefficient: 0.550) followed by "risk of a new myocardial infarction" (coefficient: 0.464) and "side effect: bleeding" (coefficient: 0.400). "Frequency of intake" was less important (coefficient: 0.025). Within the 3-class GLLAMM, the variables "marital status" (p = 0.008), "highest level of education" (p = 0.003), and "body-mass index" (according to World Health Organization cluster; p = 0.014) showed a significant impact on the estimated class probabilities.
Conclusion:
Our study found "mortality risk" to be of the highest value for patients. Patient-centered care and decision making requires consideration of patient preferences; moreover, the information on preferences can be used to develop effective therapies after an ACS. The data generated will enable healthcare decision makers and stakeholders to understand patient preferences to promote patients' benefit.
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