title: Preferences for anticoagulation therapy in atrial fibrillation: the patients' view.
abstract: Since the introduction of new oral anticoagulants (NOACs), besides vitamin-K antagonists, an additional option for stroke prevention of patients with atrial fibrillation (AF) is available. The objective of this study was to assess AF patients' preferences with regard to the attributes of these different treatment options. We conducted a multicenter study among randomly selected physicians. Preferences were assessed by computer-assisted telephone interviews. We used a discrete-choice-experiment (DCE) with four convenience-related 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: <1 km/>15 km). Preferences measured in the interviews were analyzed descriptively and based on a conditional logit regression model. A total of 486 AF patients (age: 73.9 ± 8.2 years; 43.2 % female; mean CHA2DS2-VASc: 3.7 ± 1.6; current medication: 48.1 % rivaroxaban, 51.9 % VKA) could be interviewed. Regardless of type of medication, patients significantly preferred the attribute levels (in order of patients' importance) "once daily intake" (Level: once = 1 vs. twice = 0; Coefficient = 0.615; p < 0.001), "bridging necessary" (yes = 1 vs. no = 0; -0.558; p < 0.001), "distance to practitioner of ≤1 km (>15 km = 0 vs. ≤1 km = 1; 0.494; p < 0.001), "interactions with food/nutrition" (yes = 1 vs. no = 0; -0.332; p < 0.001) and "need of INR controls/dose adjustment" (yes = 1 vs. no = 0; -0.127; p < 0.001). In our analyses, "once daily frequency of intake" was the most important OAC-attribute for patients' choice followed by "no bridging necessary" and "no interactions with food/nutrition". Thus, patients with AF seem to prefer treatment options which are easier to administer.
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Alter Holzhafen 19, 23966, Wismar, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Böttger
authors.affiliation: Bayer Vital GmbH, Kaiser-Wilhelm-Allee 70, 51373, Leverkusen, Germany.
authors.forename: Inga-Marion
authors.initials: IM
authors.lastname: Thate-Waschke
authors.affiliation: Department of Vascular Medicine, Klinikum Darmstadt GmbH, Grafenstr. 9, 64283, Darmstadt, Germany.|Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany.
authors.forename: Rupert
authors.initials: R
authors.lastname: Bauersachs
authors.affiliation: Institut für Community Medicine, University Hospital Greifswald, Walther-Rathenau-Straße 48, 17475, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohlmann
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Alter Holzhafen 19, 23966, Wismar, Germany. thomas.wilke@ipam-wismar.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D007407:Interviews as Topic; D008297:Male; D057240:Patient Preference
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation therapy; Atrial fibrillation; Discrete-choice design; Patients’ preferences