MANY WILLING TO DIE MONTHS EARLIER TO AVOID DAILY PILLING

About one in three adults would risk losing time off the end of their lives to avoid taking a daily pill to prevent cardiovascular disease, suggests a survey of individuals professionally recruited for such a study^[1]. The sample included a mix of people, more than half of them women, some of whom were taking daily medications already, while others were not.

Moreover, about one in five respondents said they would pay at least $1000 if it meant not taking a daily pill for the rest of their lives, in the analysis published February 3, 2015 in Circulation: Cardiovascular Quality and Outcomes.

The report's actual main finding: the "mean utility" for taking a daily pill for prevention of cardiovascular disease was about 0.990 to 0.994, depending on the algorithm used, in the sample of 1000 adults aged >30 years. Respondents had been instructed that the hypothetical pills would be free and not to consider side effects.

Lead author Dr Robert Hutchins (University of California, San Francisco) told  heartwire that the study was inspired by cost-effectiveness analyses that used a utility value of 1.0 for taking pills.

"That didn't make much sense to me, because a utility value of 1.0 would indicate that there was no effect on quality of life from taking medication. And I was sure that having to take a pill every day would affect people's quality of life to some extent."

Many respondents said that it would not affect quality of life, according to Hutchins. Indeed, more than two-thirds of the respondents said they would not give up years of lifetime to avoid taking daily pills. "But there were others who said, this would have a pretty big effect on my quality of life.

"Our findings could have large policy implications, because even small decrements from a utility value of 1.0 can have large effect on cost analyses when you multiple them across millions of people."

The respondents, who had completed the survey online, averaged 50 years in age; 59% were women, about 63% were white, and just over half reported an annual income of $25 000 to $75 000. More than half, 54% of respondents, reported already taking three or more pills a day.

According to one method of calculation, respondents were willing to trade a mean of 12.3 weeks off the end of their life to avoid taking a daily pill. That translated into utility value of 0.990, the group reported.

By a different analysis, 62.1% were not willing to trade any risk of immediate death, while about 13% were willing to risk only the smallest chance of death, 0.0001%, to avoid daily pill-taking. Nine percent reported being willing to risk a 10% chance of death, the largest option offered. The mean utility value using this method was 0.991.

Approximately 41% of those surveyed were unwilling to pay any amount to avoid taking a daily med, according to yet another algorithm. Still, on average, respondents as a whole were willing to pay $1445 to avoid taking a pill every day for the rest of their life. That corresponded to a mean utility of 0.994.

In an analysis by number of daily pills actually taken by respondents, "in general, the trend was that people who took no pills said that taking this theoretical pill would not affect the quality of their life, while those who took one, two, or three pills a day said that this would have more of an effect on their quality of life," Hutchins said, with those taking at least three daily pills showing the lowest utility value.

In one of the analyses, mean utility values were also significantly lower in men and with older age and nonwhite race and in those reporting more difficulty obtaining pills.

Hutchins said the current study "has very large policy implications." For example, he and his coauthors cite a past study in women that applied a utility value of 1.0 to explore the cost of quality of adjusted life-years (QALY) gained from primary-prevention aspirin.

In that analysis, they write, using any utility value below approximately 0.9996 caused a large increase in the cost per QALY. By lowering the utility value to 0.995, the cost exceeded $200 000 per QALY—well above the $50 000 typically used as a benchmark.

"Such analyses highlight the importance of having an accurately measured utility value for pill-taking rather than simply relying on arbitrary levels or expert opinion, as has often been previously done," according to the group.

The study was funded by the National Cancer Institute. The authors have reported no relevant financial relationships.