Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies.
The objective of this study was to compare patient and physician preferences for different antithrombotic therapies used to treat nonvalvular atrial fibrillation (NVAF).



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.



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.



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.
Precision Health Economics, Los Angeles, CA, USA. Electronic address: Jason.shafrin@precisionhealtheconomics.com.
Jason
J
Shafrin
Bristol-Myers Squibb, Plainsboro, NJ, USA.
Amanda
A
Bruno
Precision Health Economics, Los Angeles, CA, USA.
Joanna P
JP
MacEwan
Precision Health Economics, Los Angeles, CA, USA.
Avrita
A
Campinha-Bacote
Pfizer, Inc., New York, NY, USA.
Jeffrey
J
Trocio
Bristol-Myers Squibb, Plainsboro, NJ, USA.
Manan
M
Shah
Pfizer, Inc., New York, NY, USA.
Wilson
W
Tan
University of Southern California, Los Angeles, CA, USA.
John A
JA
Romley
D000328:Adult; D000368:Aged; D000925:Anticoagulants; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002755:Choice Behavior; D003365:Costs and Cost Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data*; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology*; D010865:Pilot Projects; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin
anticoagulants; atrial fibrillation; discrete choice experiment; preferences; willingness to pay