Daily pill? No thanks, I’ll take early death


Among 1,000 adults in a survey, one in three said they would rather shorten their life by up to 2 years than take a daily pill for the rest of their lives to reduce their risk of cardiovascular disease.

One in five said they would be willing to pay more than $1,000 to avoid taking a pill every day.

Findings from the survey of 1,000 adults in the U.S. older than 30 confirm what physicans with waiting rooms filled with drug nonadherent patients have long known: people don’t like taking pills when they don’t feel sick.

“What we were really trying to measure is how much the act of taking a pill — obtaining it, remembering to take it, and actually taking it — interferes with one’s quality of life,” researcher Robert Hutchins, MD, MPH, of the University of California San Francisco noted in a written press statement. “Even ignoring the side-effects of pills, the act of having to take a daily pill can have a large effect on an individual’s quality of life.”

Hutchins and colleagues from UCSF and the University of North Carolina, Chapel Hill, reported their findings in the latest issue of the journal Circulation: Cardiovascular Quality and Outcomes, published online Feb. 3.

‘Patients Perceive Drugs as Less Important Than Lifestyle’

Their findings don’t surprise cardiologist Lisa Rosenbaum, MD, of Brigham and Women’s Hospital, Boston, who is also a national correspondent for the New England Journal of Medicine.

Rosenbaum’s own recent informal survey of 20 people who had just had myocardial infarctions (MIs) showed that even many of these patients did not feel they needed to take prescribed medications to lower their risk for having a second heart attack.

“Most said they were willing to make other lifestyle changes like eating better, exercising, or not smoking,” she told MedPage Today. “But many didn’t see taking a pill as part of this equation. They didn’t see it as being that important.”

A large majority of respondents (79%) in the newly published cross-sectional, Internet-based survey, conducted in March of 2014, reported taking one or more pills a day. Most (59%) of those surveyed were female and white (63%), 28% had less than a college degree, and the average age was 50.

Those surveyed were asked to respond to several hypothetical scenarios, including how much time they would be willing to forfeit at the end of their lives to avoid taking daily medications for cardiovascular disease and how much money they would be willing to spend now to avoid daily medication. They were also asked to estimate the risk of death they were willing to accept to avoid daily preventive heart drugs.

The respondents were told the medications would not cost them anything and to ignore potential side effects, to minimize the influence of these possible confounders.

8% Said They Would Trade 2 Years of Life

Heavy resistance to daily pill-taking was not the norm for respondents — 70% said they were not willing to trade any amount of lifespan to avoid taking a preventive pill each day in a time-tradeoff analysis. Similarly, when daily pills were presented in a gambling scenario, 62% would not risk any chance of death to avoid the medication routine.

Still, across the entire sample, the mean lifespan that respondents were willing to give up to avoid daily pills was 12.3 weeks. The mean risk of death that all respondents would take was 0.9%.

Those surveyed were willing to pay an average of $1,445 to avoid taking a daily pill.

Among the other survey findings:

  • More than 8% of respondents said they were willing to trade 2 years of life to avoid daily heart drugs, while roughly 21% said they would trade from 1 week to 1 year of life.
  • Roughly 13% said they would accept minimal risk of immediate death to avoid taking a pill every day, while 9% said they would risk a 10% chance of death. Another 62% said they would not be willing to gamble any risk of immediate death.
  • Roughly one in five patients (21%) said they would pay $1,000 or more to avoid taking a pill each day for the rest of their lives, and just over 10% said they would pay between $5,000 and $25,000. Close to 43% said they would not pay any amount.

In general, dislike of daily pill-taking was greater among older and nonwhite respondents, those currently taking multiple daily pills, and those reporting difficulty in obtaining medications.

In an email exchange with MedPage Today, Hutchins said the study findings have significant implications for researchers and policymakers.

“We think that using the data from our study for cost-effectiveness analyses will help make those studies more accurate in their results, which could have major implications for what interventions (specifically pills) are recommended for prevention, from a cost-effectiveness standpoint,” he noted.

He said the main take-away for clinicians is that their patients don’t like taking pills.

“Hopefully it helps open the conversation about the significant benefits of many of these medications,” he said. “That being said, patients get the final say and, if they prefer not to take pills, that is a decision they make. It’s a value judgment.”

Half of Patients Don’t Take Med as Prescribed

About half of patients in the U.S. don’t take their medications as prescribed, including patients who have had heart attacks.

In an analysis published last month in NEJM, Rosenbaum explored the reasons for patient reluctance to take preventive medications following an MI.

She noted that many patients she talked to viewed the need for medication as proof of their failure to achieve health goals through lifestyle modification.

“Lifestyle modifications are an essential aspect of treatment after myocardial infarction and can empower patients to take control of their health,” she wrote. “The challenge is that adopting healthy behaviors may be perceived as a substitute for medication.”

Rosenbaum said clinicians still have little formal training in how to communicate this message to their patients, and this contributes to the problem.

“Communication is not treated like a science and it should be,” she said. “Giving patients more information is not always the answer. We need to deliver the information in more effective ways.”

Hutchins and colleagues noted several limitations to the study: test-retest reliability was not evaluated, participants might have been thinking about pill costs or side effects even though they were told not to, and the results may not be generalizable to daily medications for reasons other than cardiovascular disease prevention.

This article was originally published at http://www.medpagetoday.com/Cardiology/Prevention/49903http://


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