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Reduce Mortality Risk Above All Else: A Discrete-Choice Experiment in Acute Coronary Syndrome Patients

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Abstract

Background and Objective

Cardiovascular disease is the main cause of death in Germany and other industrialized countries. However, until now, little has been known about how people with acute coronary syndrome (ACS) value aspects of their medical treatment. The objective of this study was to evaluate patients’ preferences regarding different antiplatelet medication options following an ACS.

Method

After identification of patient-relevant treatment attributes (a literature review and qualitative interviews), a discrete-choice experiment (DCE) including five patient-relevant attributes was conducted. The DCE used a forced-choice approach in which no “opt out” was present, as no treatment is not an option after ACS. The attribute and level combinations were created using a fractional–factorial NGene design with priors. Data analysis was performed using a random-effects logit model. An additional generalized linear latent and mixed models (GLLAMM) analysis was performed to evaluate subgroup differences.

Results

ACS patients (N = 683) participated in computer-assisted personal interviews. Preference analysis showed a clear dominance of the attribute “mortality risk” (coefficient: 0.803). Ranked second was “side effect: dyspnea” (coefficient: 0.550) followed by “risk of a new myocardial infarction” (coefficient: 0.464) and “side effect: bleeding” (coefficient: 0.400). “Frequency of intake” was less important (coefficient: 0.025). Within the 3-class GLLAMM, the variables “marital status” (p = 0.008), “highest level of education” (p = 0.003), and “body-mass index” (according to World Health Organization cluster; p = 0.014) showed a significant impact on the estimated class probabilities.

Conclusion

Our study found “mortality risk” to be of the highest value for patients. Patient-centered care and decision making requires consideration of patient preferences; moreover, the information on preferences can be used to develop effective therapies after an ACS. The data generated will enable healthcare decision makers and stakeholders to understand patient preferences to promote patients’ benefit.

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Acknowledgments

The authors would like to thank E. Piletzki and Dr. H. Brauer (Rehaklinik Silbermühle, Plau am See, Germany) for their help organizing the pre-test interviews and all of the participants taking part in the study.

Author’s declaration

AM developed, designed and coordinated the study, contributed to data analysis, data interpretation and revised the paper. SB carried out the questionnaire studies, contributed to data analysis, study design and drafted the paper.

Conflict of interest

This study was funded by AstraZeneca GmbH, Germany. AM and SB declare no conflict of interest.

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Authors and Affiliations

  1. IGM Institut Gesundheitsökonomie und Medizinmanagement, Hochschule Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany

    Axel C. Mühlbacher & Susanne Bethge

  2. Gesellschaft für empirische Beratung GmbH (GEB), Freiburg, Germany

    Axel C. Mühlbacher

Authors
  1. Axel C. Mühlbacher
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  2. Susanne Bethge
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Correspondence to Susanne Bethge.

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Mühlbacher, A.C., Bethge, S. Reduce Mortality Risk Above All Else: A Discrete-Choice Experiment in Acute Coronary Syndrome Patients. PharmacoEconomics 33, 71–81 (2015). https://doi.org/10.1007/s40273-014-0223-1

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  • DOI: https://doi.org/10.1007/s40273-014-0223-1

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