Perceived value of antihypertensives for dementia, heart disease, or death: a randomized experiment

Background Many eligible patients elect not to use antihypertensive medications. It is unclear if highlighting certain disease-specific benefits could elicit a stronger desire to take antihypertensive medication and thus offer a low-touch method to increase medication use. We tested the hypothesis that framing the benefits of antihypertensives to prevent specific pathology, such as dementia, would affect how patients value antihypertensive medication. Methods We conducted a randomized, web-based experiment among census-matched participants from the United States ≥50 years of age via CloudResearch Prime Panels. Participants were randomized 1:1:1:1 to one of four framing vignettes describing a clinician’s recommendation to start antihypertensive therapy emphasizing prevention of (1) dementia, (2) cardiovascular disease (CVD), (3) death, or (4) all three combined. The primary outcome was self-reported monthly willingness to pay (WTP) out-of-pocket for the medication. Secondary outcomes included WTP as a proportion of income, total perceived value, intention to discuss hypertension with a clinician, and WTP among subgroups of participants. Results Of the 1,023 randomized participants, 907 responses met quality metrics and were included in the final sample. Mean participant age was 63.6 (standard deviation [SD]=9.6) years; 52.1% were women. The proportion of adults willing to pay >$0 exceeded 85% in all arms. Across arms, median monthly WTP out-of-pocket was $20 (interquartile range 10–50) with no significant differences by framing (p = 0.79) or in subgroups. Conclusion Framing antihypertensive medication benefits around prevention of dementia, CVD, death, or their combination did not impact financial value assigned to antihypertensive treatment.