Patient Preferences for Lipid-Lowering Agents in Hypercholesterolemia: A Discrete Choice Experiment

OBJECTIVES: Non-adherence to lipid-lowering agents jeopardizes patient health and reduces treatment efficacy. Although prior studies explored patients' attitudes, evidence on patient preferences for agent characteristics remains limited. Thus, this study aimed to assess preferences for lipid-lowering agents in patients with hypercholesterolemia. METHODS: A cross-sectional discrete choice experiment survey was conducted in person at a university-affiliated hospital. Patients chose between hypothetical lipid-lowering agents described by 6 attributes: treatment regimen, side effects, drug interactions, relative risk reduction of major adverse cardiovascular events, reduction in low-density lipoprotein cholesterol levels, and annual out-of-pocket cost. A mixed logit regression model evaluated the relative importance of each attribute and estimated marginal willingness to pay, adjusted for demographics, health conditions, and medication use. RESULTS: Among 306 participants, the strongest disfavored regimens were once-monthly (β = -0.68; 95% CI: -0.88, -0.48) and 6-monthly injections (β = -0.49; 95% CI: -0.67, -0.32) versus daily oral administration. Moderate side effects were significantly disfavored (β = -0.38; 95% CI: -0.56, -0.19), with a trend toward disfavor for mild side effects (β = -0.14; 95% CI: -0.31, 0.02). Moderate (β = -0.10; 95% CI: -0.25, 0.04) and minor drug interactions (β = -0.02; 95% CI: -0.16, 0.12), and low-density lipoprotein cholesterol reductions (β = 0.01; 95% CI: -0.06, 0.08) were not statistically significant. Participants significantly favored major adverse cardiovascular events risk reduction (β = 0.04; 95% CI: 0.02, 0.05) and were willing to pay the most (-$2342.61; 95% CI: -$3062.26, -$1622.95) to avoid once-monthly injection regimen. Subgroup and sensitivity analyses generally supported these findings. CONCLUSIONS: Findings highlight patients with hypercholesterolemia strongly disfavor injection regimens and side effects, whereas valuing reduced cardiovascular risk. Aligning medication with these preferences may improve adherence and health outcomes.