Benefit–risk assessment of HMG-CoA reductase inhibitors (statins): a discrete choice experiment

OBJECTIVES: To conduct the benefit–risk assessment of 3-hydroxy-3-methyl-glutaryl (HMG) coenzyme A reductase inhibitors (statins) using a discrete choice experiment, based on 3 major stakeholders’ perspectives including patients, experts and policymakers in Thailand. DESIGN: A discrete choice experiment questionnaire survey in three stakeholders’ perspectives. SETTING: Public hospitals in Thailand. PARTICIPANTS: A total of 353 policymakers, experts and patients. OUTCOMES: Stakeholders’ preferences for assessment criteria (stroke reduction, myocardial infarction reduction, myalgia and hepatotoxicity). Statins’ ranking and maximum acceptable risk in all perspectives were also calculated. RESULTS: For any perspective, the most and least important criteria were the risk of hepatotoxicity and the benefit of myocardial infarction reduction, respectively. Patients and experts agreed on the order of importance for myalgia and stroke reduction, but policymakers had different order of importance in these criteria. Overall, results showed that the highest and lowest chances of being chosen were atorvastatin and rosuvastatin, respectively. Only patients’ ranking order was different from others. Maximum acceptable risk of hepatotoxicity was lower than that of myalgia, reflecting the greater concern of all perspectives to statin consequence on liver. CONCLUSIONS: The results of benefit–risk assessment from every perspective were somewhat consistent. This study demonstrated the feasibility of applying a discrete choice experiment in the benefit–risk assessment of drugs and encouraged the engagement of multiple stakeholders in the decision-making process.