Assessment of women’s treatment preferences for vasomotor symptoms due to menopause

Figures & data

Table 1. Attributes and levels included in the DCE.

Treatment Attributes	Level 1 (Least Favorable)	Level 2	Level 3 (Most Favorable)
Reduction in the number of hot flashes and/or night sweats per week	50%	70%	80%
Reduction in the severity of hot flashes and/or night sweats^a	No change in severity	Moderate improvement from severe to moderate or from moderate to mild	Substantial improvement from severe to mild
Improvement in sleeping problems^b	No change in sleep problems	Moderate improvement from severe to moderate or from moderate to mild	Substantial improvement from severe to mild
Risk of breast cancer in 6 years, n/N (%)	45/10,000 (0.45)	30/10,000 (0.30)	NA
Risk of cardiovascular events in 6 years, n/N (%)	40/10,000 (0.40)	25/10,000 (0.25)	NA
Risk of short-term side effects (eg, weight gain, headache, nausea), n/N (%)	30/100 (30)	15/100 (15)	5/100 (5)
Out-of-pocket costs, USD	$75/mo	$45/mo	$15/mo

^aMild VMS are associated with the sensation of heat without sweating or dampness. Moderate VMS are associated with the sensation of heat and sweating or dampness, but the person is able to continue activity. Severe VMS result in intense heat and sweating, which causes a disruption of activity.

^bMild sleep problems cause sleep that is somewhat restless and somewhat refreshing, resulting in only fair sleep quality. Moderate sleep problems often create problems sleeping or staying asleep, resulting in poor sleep quality. Severe sleep problems almost always cause trouble sleeping or staying asleep, resulting in sleep quality that is very poor.

DCE, discrete choice experiment; NA, not applicable; VMS, vasomotor symptoms (hot flashes and/or night sweats).

Figure 1. Survey respondents.

^aCurrent HT users took estrogen and/or progesterone pills and patches or selective estrogen receptor modulators. Women taking both HT and non-HT products were placed in the Current HT Users category.

^bNon-HT products specifically listed as examples in the survey (along with their brand names) included selective serotonin reuptake inhibitors (eg, paroxetine, fluoxetine, sertraline, escitalopram), serotonin-norepinephrine reuptake inhibitors (eg, venlafaxine), clonidine, gabapentin, or black cohosh; it was also noted that there might be others.

HT, hormone therapy.

Table 2. Respondent Sociodemographic and Disease characteristics.

Respondent characteristics	Overall cohort (N = 467)	Current users (n = 124)	Past users (n = 98)	Never users (n = 245)
Age at survey date, years
Mean ± SD	53.7 ± 6.9	51.5 ± 7.4	56.1 ± 6.2	53.8 ± 6.6
Median (IQR)	55.0 (50.0, 59.0)	53.0 (44.5, 57.0)	57.0 (52.0, 60.0)	54.0 (50.0, 59.0)
Range	40–65	40–65	40–65	40–65
Race, n (%)
Native American or Alaska Native	16 (3.4)	5 (4.0)	5 (5.1)	6 (2.4)
Asian or Pacific Islander	7 (1.5)	1 (0.8)	0 (0.0)	6 (2.4)
Black	40 (8.6)	9 (7.3)	6 (6.1)	25 (10.2)
White	403 (86.3)	109 (87.9)	88 (89.8)	206 (84.1)
None of the above	11 (2.4)	5 (4.0)	1 (1.0)	5 (2.0)
Prefer not to answer	3 (0.6)	0 (0)	1 (1.0)	2 (0.8)
Education level, n (%)
High school or less	98 (21.0)	24 (19.4)	19 (19.4)	55 (22.4)
Some college or bachelor’s degree	292 (62.5)	71 (57.3)	64 (65.3)	157 (64.1)
Advanced degree	77 (16.5)	29 (23.4)	15 (15.3)	33 (13.5)
Annual household income, n (%)
<$25,000	70 (15.0)	19 (15.3)	13 (13.3)	38 (15.5)
$25,000–$49,999	110 (23.6)	17 (13.7)	32 (32.7)	61 (24.9)
$50,000–$99,999	146 (31.3)	40 (32.3)	24 (24.5)	82 (33.5)
$100,000–$149,999	82 (17.6)	32 (25.8)	20 (20.4)	30 (12.2)
$150,000–$199,999	26 (5.6)	9 (7.3)	5 (5.1)	12 (4.9)
≥$200,000	20 (4.3)	5 (4.0)	2 (2.0)	13 (5.3)
Prefer not to answer	13 (2.8)	2 (1.6)	2 (2.0)	9 (3.7)
Menopause stage, n (%)
Perimenopause	89 (19.1)	34 (27.4)	11 (11.2)	44 (18.0)
Postmenopause	378 (80.9)	90 (72.6)	87 (88.8)	201 (82.0)
Time since last menstrual period (perimenopausal women), years	N = 89	n = 34	n = 11	n = 44
Mean ± SD	0.2 ± 0.2	0.3 ± 0.2	0.4 ± 0.3	0.2 ± 0.2
Median (IQR)	0.2 (0.1, 0.3)	0.2 (0.1, 0.4)	0.3 (0.2, 0.5)	0.1 (0.1, 0.2)
Range	0.1–0.9	0.1–0.8	0.1–0.9	0.1–0.8
Time since final menstrual period (postmenopausal women),^a years	N = 366	n = 81	n = 87	n = 198
Mean ± SD	6.8 ± 6.1	6.2 ± 6.1	8.0 ± 7.5	6.5 ± 5.3
Median (IQR)	5.1 (2.3, 10.0)	3.5 (1.5, 8.2)	5.5 (3.0, 10.1)	5.3 (2.3, 10.0)
Range	0.2–38.3	1.0–30.6	1.0–38.3	0.2–33.2
Prior surgery, n (%)
Hysterectomy	50 (10.7)	17 (13.7)	13 (13.3)	20 (8.2)
Oophorectomy	62 (13.3)	18 (14.5)	18 (18.4)	26 (10.6)
Unilateral oophorectomy	10 (16.1)	1 (5.6)	4 (22.2)	5 (19.2)
Bilateral oophorectomy	52 (83.9)	17 (94.4)	14 (77.8)	21 (80.8)
BMI^b (kg/m2^)	N = 437	n = 112	n = 95	n = 230
Mean ± SD	27.9 ± 7.0	27.8 ± 7.4	28.1 ± 7.5)	27.8 ± 6.7
Median (IQR)	27 (23, 31)	27 (23, 32)	27 (22, 32)	27 (23, 31)
Range	13–60	13–49	15–60	13–50
Comorbidities (occurring in > 10% overall), n (%)	N = 467	n = 124	n = 98	n = 245
Arthritis	160 (34.3)	35 (28.2)	43 (43.9)	82 (33.5)
Sleep problems	157 (33.6)	57 (46.0)	33 (33.7)	67 (27.3)
Depression	142 (30.4)	49 (39.5)	26 (26.5)	67 (27.3)
Hypertension	137 (29.3)	35 (28.2)	22 (22.4)	80 (32.7)
Migraines	131 (28.1)	37 (29.8)	31 (31.6)	63 (25.7)
Diabetes	62 (13.3)	16 (12.9)	8 (8.2)	38 (15.5)

^aWhile this question asked for years since last period among postmenopausal women, some women potentially interpreted this as age at last period as their responses seemed improbable (eg, last periods occurring when woman was younger than age 20 years). As a result, their responses were set to missing.

^bBMI was calculated among women with available values for height and weight. If improbable responses were entered for either height (eg, ≤4 ft or ≥7 ft) or weight (eg, ≤65 lb or ≥ 500 lb), those responses were set to missing.

SD, standard deviation; IQR, interquartile range; BMI, body mass index.

Table 3. Respondent vasomotor symptoms.

Respondent VMS	Overall cohort (N = 467)	Current users (n = 124)	Past users (n = 98)	Never users (n = 245)
Time since onset of hot flashes and/or night sweats,^a years	N = 462	n = 119	n = 98	n = 245
Mean ± SD	6.0 ± 5.5	4.5 ± 4.8	8.0 ± 6.8	5.9 ± 4.9
Median (IQR)	4.5 (2.0, 9.5)	3.0 (1.2, 5.5)	6.0 (3.0, 10.1)	5.0 (2.0, 10.0)
Range	0.1–35.0	0.1–21.0	0.3–35.0	0.1–30.3
Number of hot flashes and/or night sweats^b	N = 466	n = 124	n = 98	n = 244
Among all women with ≥1 week with ≥ 14 hot flashes and/or night sweats during the last month
Mean ± SD	23.3 ± 14.4	23.4 ± 13.6	24.2 ± 16.1	22.9 ± 14.2
Median (IQR)	19.0 (14.0, 25.0)	20.0 (15.0, 26.0)	19.0 (14.0, 25.0)	18.0 (14.0, 25.5)
Range	14–133	14–90	14–97	14–133
Symptoms during the last month, n (%)^c	N = 467	n = 124	n = 98	n = 245
Hot flashes	441 (94.4)	118 (95.2)	94 (95.9)	229 (93.5)
Night sweats	413 (88.4)	111 (89.5)	88 (89.8)	214 (87.3)
Insomnia and/or sleeping problems	343 (73.4)	85 (68.5)	75 (76.5)	183 (74.7)
Irritability	263 (56.3)	70 (56.5)	51 (52.0)	142 (58.0)
Mood swings	241 (51.6)	70 (56.5)	40 (40.8)	131 (53.5)
Memory problems	218 (46.7)	58 (46.8)	42 (42.9)	118 (48.2)
Urogenital symptoms	188 (40.3)	51 (41.1)	46 (46.9)	91 (37.1)
Other symptoms^d	9 (1.9)	2 (1.6)	4 (4.1)	3 (1.2)
Severity of hot flashes and/or night sweats during the last month, n (%)^e	N = 467	n = 124	n = 98	n = 245
Mild	63 (13.5)	15 (12.1)	11 (11.2)	37 (15.1)
Moderate	255 (54.6)	70 (56.5)	51 (52.0)	134 (54.7)
Severe	120 (25.7)	32 (25.8)	29 (29.6)	59 (24.1)
Very severe	29 (6.2)	7 (5.6)	7 (7.1)	15 (6.1)
Severity of sleeping problems during the last month, n (%)^f	N = 343	n = 85	n = 75	n = 183
Mild	42 (12.2)	10 (11.8)	9 (12.0)	23 (12.6)
Moderate	172 (50.1)	41 (48.2)	34 (45.3)	97 (53.0)
Severe	129 (37.6)	34 (40.0)	32 (42.7)	63 (34.4)

^aWhile this question asked for years since onset of VMS, 5 women potentially interpreted this as age at onset of VMS as their responses seemed improbable (eg, onset of VMS occurring when less than 20 years old). As a result, their responses were set to missing.

^bWhile this question asked for a respondent’s total number of hot flashes and/or night sweats during the last week, 1 woman potentially evaluated a longer time frame and reported 200 night sweats. As a result, her response was set to missing.

^cTo be included in the study, women need to have hot flashes and/or night sweats during the last month.

^dOther menopausal vasomotor symptoms reported included fatigue, loss of sex drive, headache, joint pain, foot pain, facial hair, severely dry skin, acne on neck, hair thinning, and weight gain.

^eSeverity of VMS was self-interpreted by respondents and was an average rating during the last month. Mild hot flashes and/or night sweats are associated with the sensation of heat without sweating or dampness. Moderate hot flashes and/or night sweats are associated with the sensation of heat and sweating or dampness but the person is able to continue activity. Severe hot flashes and/or night sweats result in intense heat and sweating, which causes a disruption of activity.

^fMild sleeping problems cause sleep that is somewhat restless and somewhat refreshing, resulting in fair sleep quality. Moderate sleeping problems often create problems sleeping or staying asleep, resulting in poor sleep quality. Severe sleeping problems almost always cause trouble sleeping or staying asleep, resulting in sleep quality that is very poor. The reported severity was an average rating during the last month.

SD, standard deviation; IQR, interquartile range; VMS, vasomotor symptoms (hot flashes and/or night sweats).

Table 4. Treatment characteristics among current treatment users.

Respondent treatment characteristics	Current HT users^a (n = 63)	Current non-HT users^b (n = 61)
Out-of-pocket costs for VMS treatments per month, including OTC nonprescription medication, USD	n = 38	n = 53
Mean ± SD	80.9 ± 147.0	51.6 ± 137.2
Median (IQR)	35.0 (18.0, 80.0)	20.0 (10.0, 48.0)
Range	9–850	3–1000
Total time on current HT or non-HT treatments, months
Mean ± SD	12.9 ± 23.2	23.1 ± 25.6
Median (IQR)	6.0 (2.0, 12.0)	12.0 (6.0, 36.0)
Range	1–100	1–100
Reason for choosing the treatment, n (%)
Doctor’s prescription	49 (77.8)	37 (60.7)
I chose to use the treatment on my own and bought from a pharmacy	10 (15.9)	17 (27.9)
Doctor told me to buy from a pharmacy without prescription	3 (4.8)	4 (6.6)
Other	1 (1.6)	3 (4.9)
Satisfaction level, n (%)
Very dissatisfied	2 (3.2)	3 (4.9)
Somewhat dissatisfied	10 (15.9)	14 (23.0)
Neither dissatisfied nor satisfied	10 (15.9)	15 (24.6)
Somewhat satisfied	27 (42.9)	28 (45.9)
Very satisfied	14 (22.2)	1 (1.6)

^aWomen who reported using both HT and non-HT were counted only in the HT cohort. HT users could have taken estrogen and/or progesterone pills and patches (Climara and Premarin among others) or SERMs (a component of Duavee).

^bNon-HT users took SSRIs (paroxetine [Paxil, Brisdelle], fluoxetine [Prozac], sertraline [Zoloft], or escitalopram [Lexapro] among others), SNRIs (venlafaxine [Effexor] among others), clonidine (Catapres), gabapentin (Neurontin), or OTC treatments (black cohosh among other nonprescription treatments).

HT, hormone therapy; VMS, vasomotor symptoms (hot flashes and/or night sweats); OTC, over the counter; SD, standard deviation; IQR, interquartile range; SERM, selective estrogen receptor modulator; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin-norepinephrine reuptake inhibitor.

Figure 2. Preference weights.

^a A positive preference weight indicates that women prefer a profile with this level over the reference level of a particular attribute, and the magnitude of the preference weight indicates how strongly women prefer a profile with this level over the reference level of a particular attribute.

CI, confidence interval; DCE, discrete choice experiment.

Table 5. Estimated preference weights and marginal willingness-to-pay.

Treatment attributes	Overall cohort (N = 467)
	Preference weight (95% CI)^a	Marginal Willingness-to-pay (monthly cost, USD)	P value^b
Reduction in the number of hot flashes and/or night sweats per week
50% reduction	Reference
70% reduction	0.347 (0.253, 0.440)	19.07	<0.001*
80% reduction	0.658 (0.520, 0.796)	36.15	<0.001*
Reduction in the severity of hot flashes and/or night sweats
No change	Reference
Moderate improvement	0.600 (0.494, 0.706)	32.97	<0.001*
Substantial improvement	0.628 (0.500, 0.756)	34.51	<0.001*
Improvement in sleeping problems
No change	Reference
Moderate improvement	0.579 (0.471, 0.686)	31.81	<0.001*
Substantial improvement	0.843 (0.721, 0.965)	46.32	<0.001*
Risk of breast cancer in 6 years
45/10,000	Reference
30/10,000	0.401 (0.306, 0.496)	22.03	<0.001*
Risk of cardiovascular events in 6 years
40/10,000	Reference
25/10,000	0.150 (0.069, 0.232)	8.24	<0.001^c
Risk of short-term side effects (eg, weight gain, headache, nausea)
30%	Reference
15%	0.176 (0.065, 0.287)	9.67	0.002^c
5%	0.477 (0.366, 0.588)	26.21	<0.001^c

^aA positive preference weight indicates that women prefer a profile with this level over the reference level of a particular attribute, and the magnitude of the preference weight indicates how strongly women prefer a profile with this level over the reference level of a particular attribute.

^bP values from the random parameter logit regression models indicate whether the treatment attributes had a statistically significant effect on preference.

^cSignificant P value.

CI, confidence interval.