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Cholesterol-lowering therapy

What patients expect in return

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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.”

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Authors and Affiliations

  1. Internal Medicine Clinic, Department of Medicine, Fitzsimons Army Medical Center, 80045, Aurora, CO

    William W. Reed MD, MPH, MAJ, MC, USA

Authors
  1. William W. Reed MD, MPH, MAJ, MC, USA
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  2. Jerome E. Herbers JR. MD, LTC, MC, USA
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  3. Gordon L. Noel MD
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Additional information

Received from the Fellowship Program in General Internal Medicine, Departments of Medicine, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Reed is currently at the Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado. Dr. Noel is currently at the Department of Medicine, Veterans Affairs Medical Center, Portland, Oregon.

Supported in part by the Walter Reed Department of Clinical Investigation. Statistical review by Melissa Damiano, Fitzsimons Army Medical Center.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

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Reed, W.W., Herbers, J.E. & Noel, G.L. Cholesterol-lowering therapy. J Gen Intern Med 8, 591–596 (1993). https://doi.org/10.1007/BF02599710

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