CORONARY DISEASE PREFERENCES- A SYSTEMATIC REVIEW
Author(s)
Magliano CA, Monteiro A, Santos M
Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
Presentation Documents
OBJECTIVES: In clinical scenarios on which exists more than one clinically appropriate intervention strategy, patients preferences should inform decision-making. Preferences for different treatments may be particularly relevant for approximately 12% of patients with coronary artery disease (CAD) who are eligible for either angioplasty or surgery. While cardiologists debate on optimal revascularization method, little is understood about the patient viewpoint. This study aims to systematically identify published healthcare preference studies related to CAD. METHODS: Data sources Medline, EMBASE and Lilacs were searched on 10 December 2016. Two researchers independently reviewed titles. Disagreements were resolved by consensus. Study eligibility criteria involved preference studies related to CAD. RESULTS: Of the 1,001 citations, 11 met the inclusion criteria. Total sample size was 3,499 patients and 177 physicians. Studies were conducted in the USA (7) and Europe (4). The studies used conjoint analysis (1), standard gamble (1), rating (3), ranking (1), and willingness to pay (1). Importantly, many outcomes not used in clinical trials were valued as more important than repeat revascularization, a very usual outcome. Physicians chose angioplasty over surgery significantly less than the patients when risk of death was quoted as 4% and 6%. Overall, by respondents preferred angioplasty to surgery, even when the hypothetic risk of repeat procedure was three times the risk observed in surgery. Patients weighted stroke more significantly than clinicians did; they also considered stroke worse than death. CONCLUSIONS: This study is the first systematic review of the methods used to explore patient’s preferences between angioplasty and surgery. We considered the data scarce and identified some methodological challenges. Trials should include outcomes that are more important than repeat angioplasty and improve physician communication: neither the information given to patients nor the methods of presentation have been standardised. Compared to physicians, patients appear willing to accept considerable risk with angioplasty to avoid surgery.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PCV79
Topic
Patient-Centered Research
Topic Subcategory
Stated Preference & Patient Satisfaction
Disease
Cardiovascular Disorders