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Quantifying Pill Disutility Associated With Starting Versus Continuing Cardioprotective Medication: A Randomized
Alexander Chaitoff1, Julie C Lauffenburger1, Nancy Haff1
1Center for Healthcare Delivery Sciences, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA (A.C., J.C.L., N.H., K.T.J., N.K.C.).
Starting a new medication for heart attack and stroke prevention has a higher pill disutility for older adults than continuing an existing one. These findings offer new estimates for cost-effectiveness models in prescribing and deprescribing.
Area of Science:
- Health Economics
- Gerontology
- Pharmacoeconomics
Background:
- Quantifying patient-reported pill disutility is crucial for assessing medication risk-benefit trade-offs.
- Understanding this disutility is vital for informed treatment decisions, particularly in older adults.
Purpose of the Study:
- To quantify and compare pill disutility for starting new versus continuing existing medications for cardiometabolic disease prevention.
- To provide novel estimates for cost-effectiveness analyses in medication management.
Main Methods:
- A survey with a 2-armed experiment was administered to adults aged 60+.
- Pill disutility was measured using a time-tradeoff method and contingent valuation.
- Kruskal-Wallis test and logistic regression were used for comparisons.
Main Results:
- Pill disutility was significantly higher when starting a new medication (0.0662) compared to continuing an existing one (0.0378).
- Participants starting a new medication had 1.66 times higher odds of experiencing greater pill disutility.
- The study included 621 older adults, with a majority having chronic cardiometabolic conditions.
Conclusions:
- Pill disutility for cardioprotective medications is higher than previously reported, especially when initiating treatment.
- These findings provide the first estimates for cost-effectiveness modeling in both prescribing and deprescribing contexts.
- Rigorous ascertainment methods were employed in a sample of US older adults.
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