Abstract
BackgroundThe use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people's preferences are.MethodsWe conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design.ResultsAccording to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals.ConclusionThe rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases.
Highlights
The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes
19.6% reported that they used statins at the time of study or in the past
We studied the importance of different health outcomes related to statin therapy from the health care providers’ and the general population’s perspective in urban and rural areas
Summary
The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people’s preferences are. The various harm and benefit outcomes that are associated with using statins have been reported in previous studies [8,9,10]. Statin therapy is a crux for primary prevention of CVD, and its prescription is a preference-sensitive decision [12]. Guidelines provide tools for risk calculation and decision thresholds for preventive drug therapy and recommend shared decision for borderline CVD risks [13, 14]. This study aimed to elicit the preferences for these benefits and harms in different settings, including rural and urban areas and among healthcare providers and the general population. We used the best–worst scaling technique to elicit preferences; it is a popular method in health for its cognitive and administrative simplicity [15]
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