Background: Would provision of evidence always make a meaningful difference in care? This was examined in two studies with regard to anti-hypertensive medications in China.
Objectives: To compare the effect of evidence-based counselling on the public’s willingness to pay for anti-hypertensive drugs themselves with the actual drug-taking behaviour of insured patients.
Methods: A survey was conducted for people’s willingness to pay for anti-hypertensive drugs before and after counselling. A randomized controlled trial was conducted in mild hypertensive patients to evaluate the impact of counselling on their drug-taking behaviours in a setting where these medications are covered by insurance. The counselling included the five-year cardiovascular disease (CVD) risk, number needed to treat to benefit (NNTB) for preventing one CVD event in five years and information on costs and harms.
Results: A total of 1080 residents were included in the survey and 210 patients in the trial. Patients' willingness to pay for anti-hypertensive drugs themselves dropped from 95% before counselling to 23% immediately after counselling. The trial showed, after six months of counselling, both the rate of medication use and of good adherence showed little or moderate difference between the counselling and control groups (medication use: 65.0% vs 57.9%, P = 0.290; good adherence: 43.7% vs 40.2%, P = 0.607).
Conclusions: There is a sharp contrast in the effect of evidence on people’s willingness to pay for and actual use of anti-hypertensive medications. The payment method is likely to be the most important determinant for use of medications. These findings raised a question about whether insurance policies and clinical guidelines have faithfully reflected patients’ opinions and challenged the usefulness of informed decision-making in patients with comprehensive insurance to cover the medication.