Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease

Abstract

Background: 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.

Methods: We 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.

Results: According 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.

Conclusion: The 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.

Keywords: Benefit harm outcomes; Cardiovascular disease; Preferences; Primary prevention; Statins.

Fig. 1

Relationship between the mean Best–Worst score and its standard deviation. The figure depicts the relative importance of the outcomes among individuals according to the B–W scores' means and standard deviations. The higher the mean and lower the variance, the higher and more stable the importance ranking

Fig. 2

Individual best worst scores (BWS) (a, b) and Visual Analog Scales (VAS) (c, d) for the clinical outcomes. The ranking of the 13 outcomes by the median of individual BWS was similar to that of VAS. However, as the box plots show, there is less overlap in the BWS distributions than the VAS ones and the inconsistency of the scores based on the VAS is broader than that based on the BWS