The influence of medication costs on secondary cardiovascular prevention decisions: two discrete choice experiments among patients and prescribers

Introduction Cardiovascular (CV) preventive care expenditure continues to rise. In Europe, the financial burden falls primarily on public healthcare systems. European Society of Cardiology guidelines recommend shared decision-making in secondary CV prevention, where patients and healthcare providers weigh the benefits and harms of preventive medications, including intensified or higher-cost options. However, it remains unclear whether reimbursed medication costs influence patients’ and prescribers’ treatment decisions. Purpose To assess the relative importance of medication costs in CV preventive treatment decisions among patients with established atherosclerotic cardiovascular disease (ASCVD) and prescribers. Methods We conducted two discrete choice experiments (DCEs) in the Netherlands: one among patients with established ASCVD and one among healthcare providers prescribing preventive therapies. Participants in both groups chose between hypothetical preventive medications differing in attributes: absolute benefit in added cardiovascular disease (CVD)-free life-years, mode of administration, risk of mild side effects, and annual medication costs. We assumed no out-of-pocket costs for patients. Attributes were selected based on a patient focus group (n=7) after which wording was refined through interviews. A blocked Bayesian D-efficient design based on a pilot study was used to maximize statistical efficiency. Mixed multinomial logit models estimated the relative importance of each attribute on medication decisions and willingness to pay annually for one additional CVD-free life-year. Results Preliminary analyses include 106 patients (47 female; mean age 59 ±13 years) and 96 healthcare providers (63 female; mean age 44 ±12 years). Recruitment is ongoing. Healthcare providers comprised 22 General Practitioners or trainees, 39 Internal Medicine specialists or trainees, 14 Cardiologists or trainees, and 21 allied professionals or others. For patients, absolute benefit had the greatest relative influence on choice (β = 2.74, 95% CI 1.79 to 3.68 per additional CVD-free life-year), followed by costs (β = -0.26, 95% CI -0.34 to -0.17 per €1,000) (Figure 1). For prescribers, absolute benefit (β = 1.75, 95% CI 1.27 to 2.24) and cost (β = -0.48, 95% CI -0.56 to -0.40 per €1,000 annually) were most influential, with costs relatively more important than for patients. Patients’ willingness to pay for one additional CVD-free life-year was €9,782 annually, and prescribers’ €3,763. Conclusion Both patients and prescribers prioritize absolute benefit and reimbursed costs in secondary CV prevention, with prescribers weighing costs nearly as heavily as absolute benefit. This highlights the potential impact of cost transparency on prescribing and shared decision-making and demonstrates healthcare professionals’ willingness to act cost-effectively.