Daily heart pill? One in three 'would prefer shorter life'

Date: Feb-04-2015 Should all older people take a daily pill to prevent heart attacks? It is an enduring question, even though the Food and Drug Administration currently says that a daily aspirin, for example, is not for everyone. Researchers are also continuing to investigate the idea of a daily "polypill" against cardiovascular disease in certain groups. But for the benefit of some extra time to live, how many people would carry the burden of daily tablets? And how many would prefer a shorter life without preventive pills such as statins?

Taking tablets every day - collecting, remembering, and consuming them - would be too much of a burden for many.

Researchers from California and North Carolina sought answers from these questions with an online survey of people averaging 50 years of age, in a sample of 1,000 eligible respondents from 18,780 email invitations.

The participants answered a hypothetical question: how much time would they be willing to cut short from the end of their lives by avoiding daily meds for cardiovascular disease prevention?

The results are published in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes, and the authors are from the University of California San Francisco (UCSF), and the University of North Carolina at Chapel Hill School of Medicine.

Over two thirds of the respondents said they would not be willing to cut short their lives by any number of weeks as a trade-off for avoiding a daily pill against cardiovascular disease (CVD) - but around 1 in 3 were willing to make a trade.

The proportions opting for specific trades were as follows:

Between 1 week and 1 year of their life - 21% of those asked

As much as 2 years of shorter life to avoid having to take a daily CVD med - over 8%.

Dr. Robert Hutchins - lead author and resident physician in the department of medicine at UCSF's division of general internal medicine - says the study was more about the practical burden of daily meds than about any concerns over their effects:

"What we were really trying to measure is how much the act of taking a pill - obtaining it, remembering to take it and actually taking it - interferes with one's quality of life.

Even ignoring the side-effects of pills, the act of having to take a daily pill can have a large effect on an individual's quality of life."

Dr. Hutchins adds: "When you consider that many adults are on numerous pills, the effect is often magnified for that person."

He says that while large individual effects are somewhat levelled out across the population, there can still be big implications for society.

"On a population level, even for the small reductions in quality of life like those found in this study, that effect multiplied across millions of people can have very large effects on the cost-effectiveness of that drug for a population," Dr. Hutchins explains.

Measuring the value of extra life

The authors of the study say it is the largest to date to quantify the "utility of pill-taking" - utility being a measure of the value that can be gained from an intervention in terms of people's preferences for health outcomes.

In this case, utility was of the "time trade-off" variety, representing the attractiveness of the maximum potential health gain (extra time compared with the usual life-expectancy) achieved by accepting the given health intervention (daily medication to prevent cardiovascular disease).

Dr. Hutchins: "The act of having to take a daily pill can have a large effect on quality of life."
Image credit: American Heart Association

The less attractive the potential gain in return for the trouble of the pharmaceutical intervention, the lower its value will be against quality-of-life and cost-effectiveness measures.

Calculated utility values can be from 0 to 1 - from death to perfect health - and in this study they represented the extra amount of potential life-expectancy that participants would be prepared to give up in return for not having to take a daily heart medication.

The survey offered the following hypothetical trades in extra life: none, 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, 12 months, 18 months or 24 months.

A utility value of 1 would have come from all respondents wanting the maximum potential increase in life from taking the intervention, and any trade on this would take chips off the value towards 0.

The answer in the survey was that people would trade a mean average of 12.3 weeks for not taking the pill, resulting in a utility value of 0.990.

That might not sound like much of a dent in the potential of a daily drug for "perfect health" - the utility value of 1 - but the authors point out that even small chinks in it have important implications for public health policy.

"Using an accurate utility value for the effect of taking a preventive medication is important, as relatively small changes in the utility can have large effects on the cost-effectiveness of the preventive service," the authors write.

While there was the dip in overall value from the hypothetical intervention across the 1,000 respondents, 70% did agree that they would want the maximum potential for perfect health (a utility of 1) from a daily pill.

In other words, over two thirds would not trade any extra life-expectancy in exchange for the pill-free option.

Gambling on health preferences

Dr. Hutchins and his co-authors used the time trade-off utility for their primary research goal, but also had secondary aims based on "standard gamble" and "willingness-to-pay" measures.

The standard gamble is a measure of an individual's preference under "uncertain situations" - in this case, "whether they may one day require cardiovascular medications and whether they would take them or risk CVD or related death."

The respondents could choose to tolerate a maximum chance of death of 10% in return for no daily pills - 9% of the participants said they would be willing to take this chance, and:

About 13% said they would accept a "minimal risk of death" to avoid taking a pill every day

About 62% would not gamble "any risk" of immediate death.

The risk of death that respondents would accept overall was 0.9%, representing a mean average utility value of 0.991.

On the willingness-to-pay measure, about a fifth of people in the survey said they would pay at least $1,000 "to avoid taking a pill each day for the rest of their lives." A large proportion, however - 43% of respondents - said they would not pay any amount to avoid having to take the medication.

The questionnaire did have some limitations, as Dr. Hutchins points out: "It is important to note that our survey only measured individuals' preferences at one point in time."

"However," he adds, "the fact that we did not see large differences gives us confidence that this effect is probably not large."

The respondents were 59% female and 63% white. Almost a third had no college degree and just over half earned between $25,000 and $75,000 a year.

Although the survey stipulated that participants would not have to pay for the pills, and told them to ignore any potential side effects, the researchers could not be certain that these issues would be disregarded in the minds of the respondents weighing up the trade-offs.

The Food and Drug Administration (FDA) has issued consumer advice on daily aspirin - we reported in May last year that the FDA does not back daily aspirin to prevent first heart attack.

Not all pill-taking ideas for cardiovascular disease prevention present a burden that would dent people's desires for the improved health. For example, the "polypill" idea is to combine numerous preventive medications in one tablet, and it may improve the acceptability of the drugs.

A US-led international study presented in September found: Polypill helps heart attack survivors take their meds. And the following three examples of 2014 media releases from cardiologists add further claims to the message:

Largest ever analysis on the use of a polypill in cardiovascular disease shows potential for improvements in patient care (5 May)

A polypill strategy to improve global secondary cardiovascular prevention (6 August)

Polypill increases adherence to post MI treatment (3 September).

Written by Markus MacGill

Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.