Background: Even in cases when comparative evidence about drugs exists, prescribers and patients often struggle to weigh the relative benefits and harms of multiple options. One complexity of drug therapy is the difficulty in making trade-offs between the benefits and harms of two or more alternatives.
Objectives: To formalize the incorporation of patient preferences into treatment selection decisions using statins as a case study.
Methods: We combined network meta-analysis and multi-criteria decision analysis. Specifically, using a systematic review and network meta-analysis of randomized trials of statins, we calculated absolute risks of all-cause mortality, coronary events, cerebrovascular events, discontinuations due to adverse events, myalgia, transaminase elevations and creatine kinase elevations associated with each statin. We then applied a structured benefit risk model that allows evidence on multiple outcomes to be combined using qualitative preference statements. When combining the evidence on multiple outcomes, we adopted simple preference statements about the relative importance of different outcomes and considered the effect of statins on preventing mortality to be more important than either coronary or cerebrovascular events, which were in turn more important than any one of the harm outcomes.
Results: Fluvastatin has a considerable probability of both being the best (41%) and worst (12%) statin (based on the combination of benefits and harms), highlighting the uncertainty in its evidence base. Both simvastatin and atorvastatin have a high probability of better rank, with a negligible probability of ranking worst: atorvastatin and simvastatin have the most favorable benefit and harm profiles.
Conclusions: In the future, summaries of clinical evidence obtained from network meta-analyses can be combined with patient preferences, and considered alongside the knowledge and clinical expertise of prescribers when making treatment selection decisions.