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Value Health. 2016 Jun;19(4):451-9. doi: 10.1016/j.jval.2016.01.001. Epub 2016 Mar 2.

Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies.

Author information

1
Precision Health Economics, Los Angeles, CA, USA. Electronic address: Jason.shafrin@precisionhealtheconomics.com.
2
Bristol-Myers Squibb, Plainsboro, NJ, USA.
3
Precision Health Economics, Los Angeles, CA, USA.
4
Pfizer, Inc., New York, NY, USA.
5
University of Southern California, Los Angeles, CA, USA.

Abstract

OBJECTIVES:

The objective of this study was to compare patient and physician preferences for different antithrombotic therapies used to treat nonvalvular atrial fibrillation (NVAF).

METHODS:

Patients diagnosed with NVAF and physicians treating such patients completed 12 discrete choice questions comparing NVAF therapies that varied across five attributes: stroke risk, major bleeding risk, convenience (no regular blood testing/dietary restrictions), dosing frequency, and patients' out-of-pocket cost. We used a logistic regression to estimate the willingness-to-pay (WTP) value for each attribute.

RESULTS:

The 200 physicians surveyed were willing to trade off $38 (95% confidence interval [CI] $22 to $54] in monthly out-of-pocket cost for a 1% (absolute) decrease in stroke risk, $14 (95% CI $8 to $21) for a 1% decrease in major bleeding risk, and $34 (95% CI $9 to $60) for more convenience. The WTP value among 201 patients surveyed was $30 (95% CI $18 to $42) for reduced stroke risk, $16 (95% CI $9 to $24) for reduced bleeding risk, and -$52 (95% CI -$96 to -6) for convenience. The WTP value for convenience among patients using warfarin was $9 (95% CI $1 to $18) for more convenience, whereas patients not currently on warfarin had a WTP value of -$90 (95% CI -$290 to -$79). Both physicians' and patients' WTP value for once-daily dosing was not significantly different from zero. On the basis of survey results, 85.0% of the physicians preferred novel oral anticoagulants (NOACs) to warfarin. NOACs (73.0%) were preferred among patients using warfarin, but warfarin (78.2%) was preferred among patients not currently using warfarin. Among NOACs, both patients and physicians preferred apixaban.

CONCLUSIONS:

Both physicians and patients currently using warfarin preferred NOACs to warfarin. Patients not currently using warfarin preferred warfarin over NOACs because of an apparent preference for regular blood testing/dietary restrictions.

KEYWORDS:

anticoagulants; atrial fibrillation; discrete choice experiment; preferences; willingness to pay

PMID:
27325337
DOI:
10.1016/j.jval.2016.01.001
[Indexed for MEDLINE]
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