Women's Treatment Preferences for Moderate to Severe Vasomotor Symptoms Associated with Menopause: Insights from the WARMER Study.

BACKGROUND AND

objectiveVasomotor symptoms (VMS) affect up to 80% of women over the course of their menopause and can impair functioning as well as quality of life. Hormone therapy (HT) is the standard of care, but concerns about long-term safety may be a barrier to uptake. Emerging non-hormonal therapies could be an alternative for some women. This study elicited benefit-risk trade-offs that post-menopausal women were willing to make to treat their VMS, with a focus on long-term safety.

methodsA discrete choice experiment (DCE) was developed and tested using iterative interviews (N = 45) with women from Australia, Canada, Denmark, France, Germany, Spain, Sweden, and the UK as well as input from a steering committee. In total, 1465 women were included in the final analysis. Women made a series of choices between two hypothetical treatments and an opt out differing in moderate to severe VMS frequency, other menopause symptom improvement, time to symptom improvement, and 5-year risks of breast cancer, blood clots and osteoporosis. Data were analysed using a finite mixture of random parameter logit models to account for complex levels of preference heterogeneity. Relative attribute importance (RAI) and maximum acceptable risk were derived from the model estimates as the main behavioural outputs.

resultsIn total, 1465 women completed the final DCE survey. The most influential attribute was the 5-year blood clot risk (RAI 26.4-28.4%). Relief of other menopause symptoms and other VMS symptoms were also important attributes. Assuming 5-9 years' use of HT with an associated relative risk of 1.97, breast cancer risk was the fourth most important attribute. Women were willing to accept an extra 0.5% blood clot risk or an extra 0.25% breast cancer risk for every 10% reduction in VMS frequency. Preferences were heterogeneous, with a model mixing three continuous parameters offering the best compromise between parsimony and data fit.

conclusionsWomen valued safe efficacious VMS treatment, with high importance on avoiding long-term risks. Reducing VMS frequency mattered over and above wider menopause symptoms; however, treatment priorities were highly individual.