PATIENT PREFERENCES FOR PHARMACEUTICAL AND INTERVENTIONAL HYPERTENSION TREATMENTS: RESULTS FROM A DISCRETE CHOICE EXPERIMENT

Abstract

Objective: To quantify patient benefit-risk preferences for interventional and pharmaceutical treatments for hypertension (HTN) using discrete choice experiment (DCE) methods. Design and method: A DCE is an established survey method commonly used to quantify preference for selected treatment attributes in hypothetical profiles, allowing estimation of tradeoffs that are acceptable when evaluating several attributes together. Respondents with physician confirmed uncontrolled HTN were presented with a series of questions with hypothetical HTN treatments with differing levels of treatment risk and benefit. Respondents could also choose no HTN treatment. A random parameters logit analysis of the survey treatment choices was used to estimate the relative preferences and importance for each attribute. Results: 400 patients completed the survey, with 52% female, mean age 59 ± 13 years, systolic blood pressure (BP) 155 ± 12 mmHg and 1.8 ± 0.9 average prescribed antihypertensive medications. Reduction in office systolic blood pressure (BP) was the most influential treatment attribute. The remaining attributes were less impactful on respondents’ treatment choice (i.e., duration of effect, whether treatment was interventional, number of daily pills, risk of vascular injury, risk of medication side effects, and risk of temporary pain and bruising). When given a choice between no HTN treatment and an interventional treatment with a 20% risk of procedure side effects, the likelihood of selecting the interventional treatment increased with the magnitude of blood pressure reduction. No more than a 2.5 mmHg reduction in office systolic BP was sufficient to offset treatment risks associated with an interventional procedure like RDN. Conclusions: Among U.S. patients with HTN, a DCE study demonstrated that BP reduction was the most important driver of choice, risks were less important, and a minimal BP reduction was sufficient to offset treatment risks associated with an interventional procedure like RDN.