Abstract
Purpose The patient's perspective is becoming increasingly important in clinical and policy decisions. This study examined atrial fibrillation (AF) patient preferences for different characteristics of nonvitamin K antagonist oral anticoagulants (NOACs). Methods A discrete choice experiment (DCE) addressing AF patients treated with NOACs in France, Germany, and the United Kingdom was conducted. The DCE included the following attributes: frequency of administration (once/twice daily), size of tablet/capsule (6–9 mm/20 mm), meal-related intake (intake with food required/independent), and distance to treating physician (1 km/10 km). Preferences were analyzed based on a conditional logit regression model. Results In total, 758 patients (males: 57.3%; mean age: 71.4 years) with an average disease duration of 5.5 years were included (apixaban/dabigatran/edoxaban/rivaroxaban: 34.0%/14.5%/6.6%/44.9%, respectively). Patients preferred NOAC treatment options characterized by once-daily dosing regimens (42.8%; p < 0.001), shorter distance to treating physicians (25.0%; p < 0.001), a small-sized tablet (21.5%; p < 0.001), and intake independent of food (10.6%; p < 0.001). Conclusions Patients primarily prefer a once-daily NOAC regimen. Individual preferences should be considered for the treatment of AF patients as this may result in improved treatment adherence and consequently better effectiveness and safety in routine clinical practice.
Highlights
Purpose. e patient’s perspective is becoming increasingly important in clinical and policy decisions. is study examined atrial fibrillation (AF) patient preferences for different characteristics of nonvitamin K antagonist oral anticoagulants (NOACs)
A discrete choice experiment (DCE) addressing AF patients treated with NOACs in France, Germany, and the United Kingdom was conducted. e DCE included the following attributes: frequency of administration, size of tablet/capsule (6–9 mm/20 mm), meal-related intake, and distance to treating physician (1 km/10 km)
Even though previous research has shown that AF patients prefer once-daily anticoagulation dosing [11, 12] therapy that does not require periprocedural bridging of anticoagulation and anticoagulation therapy that does not interact with food [12], here is only limited literature on patient preferences regarding different NOACs available. e objective of this study was to elucidate AF
Summary
Atrial fibrillation (AF) is the most commonly sustained cardiac arrhythmia. It is estimated to occur in around 3% of adults aged 20 years and older, with a higher prevalence in the elderly and in patients with comorbidities such as hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease [1]. We conducted a discrete choice experiment (DCE) to measure and quantify patient preferences for NOAC therapy in AF. E basic assumption of a DCE is that rational individuals will always choose the alternative with the higher level of expected utility In this way, the degree to which each attribute (treatment characteristic) influences the choice of the patient can be examined [15, 16]. E study included treatment characteristics identified in the literature as influencing anticoagulation therapy preferences [12] and NOAC-related factors identified in the European summaries of product characteristics for each respective anticoagulant [17,18,19,20]. Due to the lack of head-tohead randomized trials of NOACs, there is no clinical evidence of differences between the medications in terms of efficacy and safety These attributes were not included in the study. Inconsistency was assessed based on responses on the abovementioned test set. e DCE dataset was analyzed using a conditional logit regression model that included all attributes (NOAC treatment characteristics) as independent variables. e conditional logit relates the probability of choice among the alternatives (choice sets) to the characteristics of the attribute levels defining those alternatives [15]. e relative importance of the NOAC treatment attributes was estimated for the overall sample and for prespecified subgroups
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