Cholesterol-lowering therapy: what patients expect in return.

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."