title: Patient preferences and willingness to pay for different options of anticoagulant therapy.
abstract: New anticoagulant drugs alternative to vitamin K antagonists are currently under clinical evaluation. Patient's preferences should be considered in the development of new therapeutic strategies. Our study aim was to elicit patient preferences, and estimate their willingness to pay for the different treatment options. A Discrete Choice Experiment was administered to patients consecutively attending an anticoagulation clinic, either on stable oral anticoagulant therapy, or during their first visit at the time of starting therapy. Six treatment characteristics were analysed: route and number of medication administrations, frequency of monitoring, risk of some minor bleeding, the amount of attention required for drug/food interactions, requirement for dose adjustment, and out-of-pocket treatment cost. Relationships between patient's preferences and their characteristics were analysed. 255 patients participated (55 % men, with a mean age 64 years; 35.7 % on stable therapy). A statistically significant importance was attributed to all but two characteristics (the amount of attention required for interaction with other drugs/food and for dose adjustment.) Monthly patient willingness to pay was <euro> 79 for tablets versus injections; <euro> 41 for once-daily versus twice-daily tablets, <euro> 25 for drugs without risk of minor bleeding events and <euro> 20 for once-monthly versus twice-monthly monitoring. Patients on stable therapy considered more important the amount of attention required for drug/food interactions than did the starters. Younger or working patients considered the reduction of monitoring frequency more important than did the older or not working patients (retired, housewives). This study elicited preferences from patients on oral anticoagulant therapy with a simple and well established method, which allows to obtain information warranted for planning optimal healthcare.
authors.affiliation: Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moia
authors.forename: Lorenzo Giovanni
authors.initials: LG
authors.lastname: Mantovani
authors.forename: Monica
authors.initials: M
authors.lastname: Carpenedo
authors.forename: Luciana
authors.initials: L
authors.lastname: Scalone
authors.forename: Mara Silvia
authors.initials: MS
authors.lastname: Monzini
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D002755:Choice Behavior; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D057240:Patient Preference; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D000925:Anticoagulants