Cholesterol-lowering therapy: what patients expect in return.

Abstract

OBJECTIVE: To assess variability in patients' values and preferences regarding cholesterol-lowering therapy. DESIGN: A descriptive study. Patients currently receiving cholesterol-lowering therapy were interviewed using the time tradeoff and standard reference gamble techniques of utility assessment. SETTING: Internal medicine clinics of a military medical center. PARTICIPANTS: Thirty-five patients, clinically free of coronary disease, receiving cholesterol-lowering therapy for at least three months. RESULTS: When the time tradeoff method was applied, 12 (34%) of the patients indicated that less than one month of additional life would be a fair return for adhering to their current therapy for the rest of their lives, while 13 (37%) patients required more than one additional year of life, and four (11%) required at least five years. By the standard reference gamble method, 18 (51%) patients would not have accepted a risk of one in a thousand of imminent death (in 30 days) in hopes of obtaining a normal life expectancy off therapy, while 14 (40%) would have agreed to a 1% or greater risk in order to avoid therapy. CONCLUSIONS: While many patients apparently expected very little in return for adhering to therapy, many others may not be getting "what they bargained for."