Quantifying patient preferences about features of nonstatin lipid-lowering therapies: a discrete choice experiment in the United States
Open accessAbstract
BACKGROUND: Despite the growing number of nonstatin lipid–lowering treatments (NS-LLTs), data are lacking on how patients value their various features and outcomes. Study objectives were to quantify patients’ preferences across levels of efficacy, treatment regimens, side effects, and out-of-pocket costs of NS-LLTs and compare approaches with framing treatment efficacy. METHODS: A discrete choice experiment survey was administered to US adults aged ≥40 years with medical claims indicating statin use and atherosclerotic cardiovascular disease. Each participant was administered 12 sets of experimentally designed pairs of add-on NS-LLT profiles that varied in efficacy, administration regimen, injection-site reaction, joint pain, out-of-pocket cost, and a no-additional treatment option. Random-parameter logit models were used to estimate preference weights, and tradeoffs across attributes were reported as willingness-to-pay estimates. RESULTS: A total of 1193 participants completed the survey (36% female; 90% White; mean age, 68.2±9.7 years). Across treatment features assessed, out-of-pocket cost ranging from $0 to $200 per month was the most important factor. All else being equal, a daily oral dosing regimen was the most preferred regimen. Among injectable regimens, participants preferred dosing every 6 months versus every 2 weeks ( P <0.001) or every month ( P <0.001). Efficacy presented as 25% to 60% reductions in LDL-C (low-density lipoprotein-cholesterol) levels was valued greater than equivalent reductions in 5-year cardiovascular risks. Among those reporting annual household incomes <$150 000 (93.5%), the average maximum willingness to pay for an add-on NS-LLT as a daily, oral medication without side effects ranged from $131 to $175 per month with efficacy framed as a 25% reduction in LDL-C levels versus $89 to $124 with efficacy framed as corresponding reductions in 5-year cardiovascular risk. CONCLUSIONS: Among treatment features assessed, out-of-pocket costs were the primary factor driving choices. Those opting for an add-on NS-LLT were willing to trade off additional efficacy for less frequent injections or a daily oral medication.
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A recent discrete choice experiment found that patients expressed a strong preference for daily oral non-statin LLT, with a willingness-to-pay of $131 to $175 per month for an oral option that achieved an approximate 25% reduction in LDL-C levels.
“A recent discrete choice experiment found that patients expressed a strong preference for daily oral non-statin LLT, with a willingness-to-pay of $131 to $175 per month for an oral option that achieved an approximate 25% reduction in LDL-C levels [46].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [46]
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Systematic literature review on the real-world effectiveness and safety of bempedoic acid
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- Authors
- Reed, S. D., Sutphin, J., Gonzalez, J. M., Wallace, M. J., Stephenson, J. J., Electricwala, B., Bosworth, H. B., & Pagidipati, N.
- Affiliations
- Duke University (US)
- Duke Clinical Research Institute (S.D.R., J.S., J.M.G., M.J.W., H.B.B., N.P.), Duke University, Durham, NC.
- Carelon Research (United States) (US)
- Novartis (United States) (US)
- Corresponding author
- Reed, Shelby D.
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2025-08
- Volume
- 18
- Issue
- 8
- Pages
- e011804-e011804
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC12356558
- OpenAlex
- W4412192379
- Cited by
- 4
- References
- 32
- Citations by year
- 2026: 4
- FWCI
- 3.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- non-statin lipid-lowering therapy, patient preferences, willingness to pay, out-of-pocket costs, dosing regimen, injectable drugs, LDL cholesterol lowering, cardiovascular risk reduction, atherosclerotic cardiovascular disease, joint pain, injection site reactions
- MeSH terms
- Adult, Aged, Hypolipidemic Agents, Cardiovascular Diseases, Choice Behavior, Cost-Benefit Analysis, Health Expenditures, Female, Humans, Lipids, Male, Middle Aged, United States, Biomarkers, Drug Costs, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Health Care Surveys, Dyslipidemias, Patient Preference
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