Background: Understanding people’s thresholds for intervention is vital for designing strategies to translate effective therapies into more individualized, patient-centered disease prevention. Accordingly, we assessed the disutility inherent to taking an antihypertensive medication (versus other antihypertensive interventions).
Methods: From March to June 2017 we conducted a survey of antihypertensive treatment preferences among 1,284 US adults recruited through Amazon MTurk and 100 patients presenting to an outpatient clinic. Participants were asked to imagine a scenario in which they had hypertension (if they did not) and to decide whether they would adopt specific interventions (tea, exercise, pill, injection) to achieve a given benefit. For example: would they drink a cup of tea daily to gain 1 month, 1 year, or 5 years of life. We estimated gains in life expectancy by age and sex, derived from meta-analyses of pills, but applied to all interventions. We calculated the difference between the calculated benefit (‘utility’) and respondents’ expressed minimum desired benefit for taking the therapy, which is a measure of undesirability (‘disutility’).
Results: The cumulative proportion of respondents willing to adopt the intervention if it prolonged life by at least 1 month, 1 year or 5 years varied, respectively: tea (78%; 91%; 96%); pills (79%; 90%; 96%); exercise (63%, 84%; 93%); monthly injections (51%; 74%; 88%); and 6 month injections (68%; 85%; 93%). Utility exceeded disutility (benefits outweighed the burdens of treatment, in months) the greatest for tea and pills (14.8 months), followed by exercise and 6 month injections (12.7 months), then 1 month injections (10 months). However, for each intervention, more than 20% of individuals considered the burden of treatment to exceed their calculated life expectancy gain (Figure).
Conclusion: In contrast to guidelines which recommend lifestyle changes such as exercise as first line, people’s preferences indicated that they would be more inclined to take a daily pill or tea to prolong their life. Substantial numbers of respondents desired gains in life years that were beyond what each treatment could maximally provide.