Article type
Year
Abstract
Background: Current recommendations on drug treatment of hypertension for primary prevention of cardiovascular disease are primarily determined by the evidence of effectiveness, disregard the resources available and values of people, and recommend a universally fixed-risk cutoff for initiating drug treatment. The guidelines may have over-estimated the willingness of the public to accept and pay for these drugs and a fixed cutoff may not fit all populations. Moreover, the public may have been misinformed and are unable to make the right decision even if they are consulted.
Objective: To describe the gap between current policy and what the public truly want.
Methods: A cross-sectional survey with face-to-face interviews of rural and urban residents in northern China.
Results: A total of 887 rural residents and 921 urban residents were interviewed with a response rate of 97%. Of these, 95% (95% confidence interval (CI) 94% to 96%) said they would take anti-hypertensive drugs if they had hypertension, although 91% (95% CI 89% to 92%) said they did not have sufficient knowledge to make a decision; 78% (95% CI 76% to 80%) believed that anti-hypertensive drugs were primarily to lower blood pressure or relieve symptoms. They over-estimated the cardiovascular risk of untreated hypertension by approximately 12 times and the absolute benefit of drug treatment by 20 times. Given the actual absolute benefit of the drugs, only 23% (95% CI 21% to 25%) were willing to pay the current annual cost of RMB 500 (USD 73.30) for these drugs. Given the current cost, they were, on average, willing to pay for the drugs only when the five-year cardiovascular disease risk was as high as 35% (95% CI 31% to 38%) or even higher.
Conclusion: The public in China are significantly misinformed and considerably over estimate the risk of hypertension and the benefit of treatment. The public's willingness to pay for anti-hypertensive drugs is much lower than the current guidelines implicitly assume. The willingness to pay should be considered, along with other factors, when prescribing anti-hypertensive drugs to an individual patient or making hypertension guidelines for a population.
Objective: To describe the gap between current policy and what the public truly want.
Methods: A cross-sectional survey with face-to-face interviews of rural and urban residents in northern China.
Results: A total of 887 rural residents and 921 urban residents were interviewed with a response rate of 97%. Of these, 95% (95% confidence interval (CI) 94% to 96%) said they would take anti-hypertensive drugs if they had hypertension, although 91% (95% CI 89% to 92%) said they did not have sufficient knowledge to make a decision; 78% (95% CI 76% to 80%) believed that anti-hypertensive drugs were primarily to lower blood pressure or relieve symptoms. They over-estimated the cardiovascular risk of untreated hypertension by approximately 12 times and the absolute benefit of drug treatment by 20 times. Given the actual absolute benefit of the drugs, only 23% (95% CI 21% to 25%) were willing to pay the current annual cost of RMB 500 (USD 73.30) for these drugs. Given the current cost, they were, on average, willing to pay for the drugs only when the five-year cardiovascular disease risk was as high as 35% (95% CI 31% to 38%) or even higher.
Conclusion: The public in China are significantly misinformed and considerably over estimate the risk of hypertension and the benefit of treatment. The public's willingness to pay for anti-hypertensive drugs is much lower than the current guidelines implicitly assume. The willingness to pay should be considered, along with other factors, when prescribing anti-hypertensive drugs to an individual patient or making hypertension guidelines for a population.