Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK

BACKGROUND: Direct treatment disutility (DTD) represents an individual’s disutility associated with the inconvenience of taking medicine over a long period of time. OBJECTIVES: The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values. METHODS: Design: We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill (‘Medicine A’) assumed to have no inconvenience and a daily pill (‘Medicine B’) over 10 years (statins) or 5 years (bisphosphonates). Setting: Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company. Participants: Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359). Primary and secondary outcome measures: Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values. RESULTS: A total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities. CONCLUSIONS: Statins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.