Patients’ Priorities for Oral Anticoagulation Therapy in Non-valvular Atrial Fibrillation: a Multi-criteria Decision Analysis

Abstract

IntroductionEffectiveness of oral anticoagulants (OACs) is critically dependent on patients’ adherence to intake regimens. We studied the relative impact of attributes related to effectiveness, safety, convenience, and costs on the value of OAC therapy from the perspective of patients with non-valvular atrial fibrillation.MethodsFour attributes were identified by literature review and expert interviews: effectiveness (risk of ischemic stroke), safety (risk of major bleeding, minor bleeding, gastrointestinal complaints), convenience (intake frequency, diet restrictions, international normalized ratio [INR] blood monitoring, pill type/intake instructions), and out-of-pocket costs. Focus groups were held in Spain, Germany, France, Italy and the United Kingdom (N = 48) to elicit patients’ preferences through the use of the analytical hierarchy process method.ResultsEffectiveness (60%) and side effects (27%) have a higher impact on the perceived value of OACs than drug convenience (7%) and out-of-pocket costs (6%). As for convenience, eliminating monthly INR monitoring was given the highest priority (40%), followed by reducing diet restrictions (27%), reducing intake frequency (17%) and improving the pill type/intake instructions (15%). The most important side effect was major bleeding (75%), followed by minor bleeding (15%) and gastrointestinal complaints (10%). Furthermore, 71% of patients preferred once-daily intake to twice-daily intake.DiscussionAlthough the relative impact of convenience on therapy value is small, patients have different preferences for options within convenience criteria. Besides considerations on safety and effectiveness, physicians should also discuss attributes of convenience with patients, as it can be assumed that alignment to patient preferences in drug prescription and better patient education could result in higher adherence.Electronic supplementary materialThe online version of this article (10.1007/s40256-018-0293-0) contains supplementary material, which is available to authorized users.

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

“…In our country, Spain, only a few MCDAs have been published in the field of healthcare [20][21][22][23][24][25][26][27][28], although the number of healthcare-related publications that incorporate MCDA is increasing in Spain and globally.…”

“…Some MCDAs have been used in our country to compare alternative treatments for various pathologies, such as chronic dermatological inflammatory diseases, cancer, rare diseases, and cardiovascular diseases such as nonvalvular atrial fibrillation and pulmonary hypertension [24][25][26]28]. Other applications of MCDA include the development of an assessment framework for rare diseases at a regional level in Catalonia [22] and the development of a decision-support tool for drug evaluation in a pharmacy and therapeutics committee setting at the hospital level [20].…”

“…Some studies have used the EVIDEM methodology to develop the analysis [20,[22][23][24][25]28]. In those studies, the methods used to prioritize the criteria were fundamentally compositional, such as direct classification or the analytic hierarchical process [22][23][24][25][26][27][28]. Either a single-stakeholder perspective was used, such as that of patients [20,21,26] or evaluation agencies [22,27], or a multidisciplinary perspective was employed, which included patients, physicians, and other stakeholders [23][24][25]28].…”

Heterogeneity in Preferences for Anti-coagulant Use in Atrial Fibrillation: A Latent Class Analysis

“…The initial list of attributes of convenience in anti-coagulation therapy was determined by a combination of literature review, focus group sessions with patients in five European countries [10,14], and expert consultation. The initial list of attributes consisted of seven attributes: [1] need for coagulation monitoring; [2] dosing regimen; [3] intake frequency;…”

“…To most patients, reducing stroke and bleeding risk is most important [8,9], but most DOACs have similar benefit-risk profiles on a population level. DOACs differ mostly from VKAs in convenience attributes (e.g., intake frequency, regular coagulation monitoring, or drug/food interaction) [10]. With regard to convenience of treatment, once-daily intake and no need for regular coagulation monitoring were found to be the most important attributes of anti-coagulation therapy; however, there is considerable heterogeneity in patient preference [8,9].…”