Patient Priorities for Coverage of New Antihypertensive Drugs: A Discrete Choice Experiment in China

Jiaran Chen,1 Chen Pan,1 Guohua Wang,2 Leilei Qian,1,3 Yiming Lu,1 Tongling Xie,1,3 Jianjun Gu,4 Jinsong Geng1 1Center for Evidence-Based Medicine, Medical School of Nantong University, Nantong, Jiangsu, 226001, People’s Republic of China; 2National Clinical Research Center for Neurological Diseases, Xuanwu Hospital Capital Medical University, Beijing, 100053, People’s Republic of China; 3Hospital Performance Evaluation Office, The People’s Hospital of Rugao, Nantong, Jiangsu, 226500, People’s Republic of China; 4Department of Neurosurgery, Henan Provincial People’s Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, 450003, People’s Republic of ChinaCorrespondence: Jianjun Gu, Department of Neurosurgery, Henan Provincial People’s Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, 450003, People’s Republic of China, Email gujianjundt@163.com Jinsong Geng, Center for Evidence-based Medicine, Medical School of Nantong University, Nantong, Jiangsu, 226001, People’s Republic of China, Email gjs@ntu.edu.cnObjective: Hypertension is a chronic condition in which patient-centered decisions are crucial for long-term adherence and outcomes. We aimed to obtain patient priorities for health insurance coverage of new antihypertensive drugs, and translate these preferences into reimbursement proposals using a discrete choice experiment.Methods: A systematic literature review and semi-structured interviews were conducted to determine the attributes and levels. A Bayesian D-efficient design with blocking techniques was used to generate choice scenarios in the experiment. We conducted one-on-one, face-to-face interviews with patients with hypertension across four provinces in China. A mixed logit model was used to estimate patient preferences, marginal willingness-to-pay, and preference heterogeneity.Results: Data analysis included 802 patients. When prioritizing new antihypertensives for health insurance coverage, patients placed more importance on improvement in health-related quality of life (HRQoL), followed by lower out-of-pocket costs per year, systolic blood pressure (SBP) control, fewer common side effects, and decreased five-year mortality due to cardiovascular diseases. Patients were willing to pay CNY 4049 (95% CI 3418– 4681) annually for significant improvements in HRQoL. Patients with higher untreated office SBP prioritized effective SBP control and the lowest five-year stroke risk.Conclusion: Hypertensive patients primarily prefer improved HRQoL, lower out-of-pocket costs, and favorable long-term health outcomes. Our findings support preference-responsive reimbursement mechanisms, such as tiered coverage based on patient-valued outcomes and risk-stratified subsidies for patients at high cardiovascular disease risk.