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Primary-care patients' trade-off preferences with regard to antidepressants

Published online by Cambridge University Press:  07 January 2014

H. Wouters ,
L. Van Dijk ,
E. C. G. Van Geffen ,
H. Gardarsdottir ,
A. M. Stiggelbout  and
M. L. Bouvy
H. Wouters*
Affiliation:
Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
L. Van Dijk
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
E. C. G. Van Geffen
Affiliation:
Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
H. Gardarsdottir
Affiliation:
Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands Department of Clinical Pharmacy, Laboratory and Pharmacy Division, University Medical Centre Utrecht, The Netherlands
A. M. Stiggelbout
Affiliation:
Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
M. L. Bouvy
Affiliation:
Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
*
*Address for correspondence: H. Wouters, Ph.D., Division of Pharmaco-epidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands. (Email: j.wouters@uu.nl)
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Abstract

Background

Antidepressants are frequently prescribed but results regarding their efficacy have been equivocal for different spectra of the severity continuum and their side-effects are often burdensome. Non-adherence is a likely consequence. The objective was therefore to examine patients’ trade-offs between the efficacy, side-effects and other drawbacks of antidepressants and whether these trade-offs predicted non-adherence.

Method

Trade-offs from 225 antidepressant users, recruited through community pharmacies, were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated utilities, relative importance scores of treatment properties were calculated. Non-adherence was measured through self-report and pharmacy refill data.

Results

Relapse prevention and symptom relief were on average equally important. Side-effects were as important and the side-effect stomach and intestine complaints was on average even slightly more important than relapse prevention and symptom relief. Additional treatment with psychotherapy was preferred by 61% of the patients. A benefit/drawback ratio revealed that 18% of the patients did not consider the efficacy to outweigh the drawbacks. A higher benefit/drawback ratio was associated with a decreased odds of intentional non-adherence [odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07–0.7, Wald = 6.7, p = 0.01).

Conclusions

For nearly one in five patients, the efficacy of antidepressants does not outweigh their drawbacks. Knowing patients’ trade-offs is likely to aid both physicians and patients to identify important treatment preferences, to improve adherence and to make more deliberate decisions on whether or not to continue treatment.

Keywords

Antidepressantsdecision aidspatient adherencepatient-centred carepatient preferences
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 11 , August 2014 , pp. 2301 - 2308
Copyright
Copyright © Cambridge University Press 2014 

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