PCV127 PATIENT PREFERENCES REGARDING ORAL ANTICOAGULANTS: RESULTS OF A DISCRETE CHOICE EXPERIMENT IN SPANISH PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH VITAMIN-K ANTAGONISTS

Abstract

Oral anticoagulation is pivotal in the management of thromboembolic risk in non-valvular atrial fibrillation (NVAF) patients. An effective anticoagulation therapy also relates on good medication adherence to achieve good anticoagulation control. One key element for reaching or sustaining a good adherence and persistence is to prescribe treatments that patients prefer. The objective of this study was to elucidate patient preferences regarding attributes that describe different anticoagulation alternatives. A multi-center discrete choice experiment (DCE) was conducted in Spain. Study sites enrolled patients aged 18+ years with NVAF, who initiated a Vitamin-K antagonist (VKA) treatment. The DCE design considered four treatment attributes: need of bridging (yes/no), interactions with food/alcohol (yes/no), need of regular international normalized ratio (INR) assessments/blood controls and subsequent dose adjustment (yes/no) and frequency of intake (once/twice daily). Distance to treating practitioner represented a neutral attribute to express patients’ overall utility in terms of a comprehensible unit. Conditional logit regression model was applied to estimate patients’ utility for each attribute and to evaluate the influence of different levels on the probability of a patient of choosing a specific OAC alternative. In total, 286 patients were included (mean age: 72.9 years, 42.0% female, mean CHA2DS2-VASc: 3.2). Patients preferred an anticoagulation treatment option characterized by “no need for bridging” (β=0.530, p<0.001), “no need for regular INR controls” (β=0.652, p<0.001), “less interactions with food/alcohol” (β=0.503, p<0.001) and “once daily intake” (β=0.360, p<0.001). To receive such a treatment option compared to a treatment that offers none of the favourable characteristics, the average patient would be willing to travel additional 57 kilometres to the treating practitioner. In our study, NVAF patients currently treated with VKA showed a strong preference for features that characterize non-VKA anticoagulation options.