gms | German Medical Science

Background/research question: Previous companion studies showed that statin guideline recommendations depend not only on treatment effects and outcome risks but also on preferences. In this study, we assessed the preference-sensitivity of net benefit or CVD risk thresholds for the initiation of statins to prevent CVD in people aged 75 years or older.

Methods: We performed a best-worst scaling survey in Switzerland for selecting benefit and harm outcomes and eliciting patient preferences. These individual patient preference values were inputted in exponential model, which additionally considered treatment effects, outcome risks, competing risk, and parameter uncertainties, to estimate the benefit-harm balance index of statins at different 10-year CVD risk spectrum. We further determined risk thresholds where statins would more likely to provide net benefit. We performed these analyses repeatedly for each patient preference values to assess how preferences affected statin benefit.

Results: Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75–79 years and 80–84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21–33% and 23–36% for men aged 75–79 years and 80–84 years, respectively, as well as 20–32% and 21–32% for women aged 75–79 years and 80–84 years, respectively.

Conclusion: The thresholds for initiating statins for older people could be much higher or lower depending on individual patient preferences, suggesting that more emphasis should be placed on individual decision-making rather than recommending statins for all based on a single or a small number of thresholds.

Competing interests: None