gms | German Medical Science

21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

13. - 15.02.2020, Basel, Schweiz

Individual recommendations of statins for older people are patient preference-sensitive: benefit-harm balance modeling study

Meeting Abstract

  • Henock Yebyo - University of Zurich, EPBI, Zurich, Schweiz
  • Hélène E. Aschmann - University of Zurich, EPBI, Zurich, Schweiz
  • Dominik Menges - University of Zurich, EPBI, Zurich, Schweiz
  • Cynthia Boyd - Johns Hopkins University, School of Medicine, USA
  • Milo Puhan - University of Zurich, EPBI, Zurich, Schweiz

Nützliche patientenrelevante Forschung. 21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Basel, Schweiz, 13.-15.02.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20ebmPP1-06

doi: 10.3205/20ebm045, urn:nbn:de:0183-20ebm0451

Published: February 12, 2020

© 2020 Yebyo et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background/research question: Previous companion studies showed that statin guideline recommendations depend not only on treatment effects and outcome risks but also on preferences. In this study, we assessed the preference-sensitivity of net benefit or CVD risk thresholds for the initiation of statins to prevent CVD in people aged 75 years or older.

Methods: We performed a best-worst scaling survey in Switzerland for selecting benefit and harm outcomes and eliciting patient preferences. These individual patient preference values were inputted in exponential model, which additionally considered treatment effects, outcome risks, competing risk, and parameter uncertainties, to estimate the benefit-harm balance index of statins at different 10-year CVD risk spectrum. We further determined risk thresholds where statins would more likely to provide net benefit. We performed these analyses repeatedly for each patient preference values to assess how preferences affected statin benefit.

Results: Based on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75–79 years and 80–84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21–33% and 23–36% for men aged 75–79 years and 80–84 years, respectively, as well as 20–32% and 21–32% for women aged 75–79 years and 80–84 years, respectively.

Conclusion: The thresholds for initiating statins for older people could be much higher or lower depending on individual patient preferences, suggesting that more emphasis should be placed on individual decision-making rather than recommending statins for all based on a single or a small number of thresholds.

Competing interests: None


Yebyo HG, Aschmann HE, Menges D, Boyd C, Puhan MA. Net benefit of statins for primary prevention of cardiovascular disease in people 75 years or older: A benefit-harm balance modeling study.Ther Adv Chronic Dis. 2019; 10: 1-19
Yebyo HG, Aschmann HE, Yu T, Puhan MA. Should statin guidelines consider patient preferences? Eliciting preferences of benefit and harm outcomes of statins for primary prevention of cardiovascular disease in the sub-Saharan African and European contexts. BMC Cardiovasc Disord. 2018; 18: 97