Abstract 11952: Physician Preferences for Treatment of Low-Density Lipoprotein Cholesterol Among Patients With Atherosclerotic Cardiovascular Disease - A Discrete Choice Experiment

Abstract

Introduction: Around 80% of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve adequate reduction of low-density lipoprotein cholesterol (LDL-C) in current clinical practice, especially among patients on statin monotherapy. Greater understanding of attributes favored by prescribing physicians may improve treatment outcomes. Methods: To understand attributes of putative statin ‘add-on’ LDL-C lowering therapies, we conducted a discrete choice experiment survey of 200 U.S. cardiologists and 50 primary care physicians (PCPs). The survey presented a series of discrete choices to respondents, systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient out-of-pocket cost (OOPC) and adherence. Data were analyzed using logistic regression with clustering and heterogeneity adjustments to estimate preference weights for each attribute. Results: Both cardiologists and PCPs most valued efficacy in LDL-C reduction, with odds ratio (OR) for treatment preference of 1.69 per additional 10% reduction in LDL-C, and minimization of monthly OOPC with OR of 0.90 per $10 increase. Cardiologists preferred injectable therapies, with 57.5% of respondents preferring a drug with attributes of a small interfering RNA (siRNA) injectable and 16.4% preferring attributes of a proprotein convertase subtilisin kexin type 9 inhibitor (PCSK9i) biologic over oral ezetimibe therapy, as compared to only 2.8% preference for siRNA injectable among PCPs vs. oral therapy. Across all respondents, preference for injectables was higher for patients with history of nonadherence, with 55.7% preferring a drug with health-care practitioner-based injection every 6 months and 25.4% preferring a drug with properties of monoclonal antibody-based home injections once or twice monthly. Conclusions: Results indicate LDL-C lowering efficacy is a primary driver of physician prescribing preferences, with PCPs placing increasing consideration on OOPC. For patients with suboptimal adherence - the majority of those seen in clinical practice - U.S. physicians are more likely to prefer less-frequent injectable to oral therapies.