Preferences Regarding The Attributes Of Oral Anticoagulants In Patients With Atrial Fibrillation Results Of A Discrete Choice Experiment

Abstract

Objectives: Since the introduction of non-vitamin-K-antagonist oral anticoagulants (OACs), an additional option for stroke prevention in patients with atrial fibrillation (AF) compared to vitamin-K-antagonists (VKAs) is available. The objective of this study was to assess patients' preferences regarding the attributes of these different treatment options. MethOds: We conducted a multicenter study among randomly selected physicians who were asked to recruit AF patients. Patients' preferences were assessed by computer-assisted telephone interviews. We used a Discrete-Choice-Experiment (DCE) with four treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/ dose adjustment: yes/no, frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: < 1km/> 15km). Preferences measured in the interviews were analyzed descriptively and based on a conditional logistic regression model. Results: A total of 140 AF patients (age: 74.0±8.5 years; 57.0% male; mean CHA 2 DS 2 -VASc: 6.1±1.1; current medication: 27.1% rivaroxaban, 71.4% VKA, 1.4% other) could be interviewed. Regardless of type of medication, patients significantly preferred the attributes' level (in order of patients' importance) "once daily" for "frequency of intake" (binary-coded: once = 1 vs. twice = 0; Coefficient = 0.954; p< 0.001), "no" for "interaction with food/nutrition" (yes vs. no; -0.842; p< 0.001), "no" for "bridging necessary" (yes vs. no; -0.656; p< 0.001) and "≤ 1 km" for "distance to practitioner" (≤ 1 km vs. > 15 km; 0.644; p< 0.001). However, for the attribute "need of INR controls/dose adjustment" (yes vs. no; 0.020; p= 0.808) no significant preference in favour of one of the options are shown. cOnclusiOns: In our analyses, "once daily frequency of intake" was the most important attribute for patients' choice followed by "no interactions with food/nutrition" and "no bridging necessary". Thus, patients with AF seem to prefer treatment options which are easier to administer.

Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies

“…Moia et al [17] concluded that patients have a high marginal WTP value to decrease bleeding risk ($31). Two recent studies found no significant preference for less frequent blood testing [18,41], but one study found that patients preferred fewer dietary restrictions [41]. There are several limitations of this study.…”