Iranian general populations' and health care providers' preferences for benefits and harms of statin therapy for primary
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RESEARCH ARTICLE
Open Access
Iranian general populations’ and health care providers’ preferences for benefits and harms of statin therapy for primary prevention of cardiovascular disease Hassan Saadati1, Hamid Reza Baradaran1,2,3*, Goodarz Danaei4, Afshin Ostovar5, Farzad Hadaegh6, Leila Janani7, Ewout W. Steyerberg8,9 and Davood Khalili6,10*
Abstract Background: The use of statins for primary prevention of cardiovascular diseases is associated with different benefit and harm outcomes. The aime of this study is how important these outcomes are for people and what people’s preferences are. Methods: We conducted a preference-eliciting survey incorporating a best–worst scaling (BWS) instrument in Iran from June to November 2019. The relative importance of 13 statins-related outcomes was assessed on a sample of 1085 participants, including 913 general population (486 women) and 172 healthcare providers from the population covered by urban and rural primary health care centers. The participants made trade-off decisions and selected the most and least worrisome outcomes concurrently from 13 choice sets; each contains four outcomes generated using the balanced incomplete block design. Results: According to the mean (SD) BWS scores, which can be (+ 4) in maximum and (− 4) in minimum, in the general population, the most worrisome outcomes were severe stroke (3.37 (0.8)), severe myocardial infarction (2.71(0.7)), and cancer (2.69 (1.33)). While myopathy (− 3. 03 (1.03)), nausea/headache (− 2.69 (0.94)), and treatment discontinuation due to side effects (− 2.24 (1.14)) were the least worrisome outcomes. Preferences were similar between rural and urban areas and among health care providers and the general population with overlapping uncertainty intervals. Conclusion: The rank of health outcomes may be similar in various socio-cultural contexts. The preferences for benefits and harms of statin therapy are essential to assess benefit-harm balance when recommending statins for primary prevention of cardiovascular diseases. Keywords: Preferences, Statins, Benefit harm outcomes, Primary prevention, Cardiovascular disease
*Correspondence: [email protected]; [email protected]; [email protected]; [email protected] 1 Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran 6 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article
Background Cardiovascular diseases contribute to over 30% of deaths worldwide and more than 40% in Iran [1, 2]. Given that the raised total cholesterol and low-density lipoprotein (LDL) cholesterol are the major risk factors for cardiovascular disease (CVD), controlling hypercholesterolemia is an important target in managing CVD risk [3]. Statins are a class of lipid-lowering drugs that have been widely
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