Mehdi Najafzadeh1, Joshua J Gagne2, Niteesh K Choudhry2, Jennifer M Polinski2, Jerry Avorn2, Sebastian S Schneeweiss2. 1. From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. mnajafzadeh@partners.org. 2. From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: With proliferating treatment options for anticoagulant therapy, physicians and patients must choose among them based on their benefits and risks. Using a Discrete Choice Experiment, we elicited patients' relative preferences for specific benefits and risks of anticoagulant therapy. METHODS AND RESULTS: We selected a sample of US patients with cardiovascular disease from an online panel and elicited their preferences for benefits and risks of anticoagulant therapy: nonfatal stroke, nonfatal myocardial infarction, cardiovascular death, minor bleeding, major bleeding, bleeding death, and need for monitoring. These attributes were used to design scenarios describing hypothetical treatments that were labeled as new drug, old drug, or no drug. Latent class analysis was used to identify groups of patients with similar preferences. A total of 341 patients completed all Discrete Choice Experiment questions. On average, patients valued a 1% increased risk of a fatal bleeding event the same as a 2% increase in nonfatal myocardial infarction, a 3% increase in nonfatal stroke, a 3% increase in cardiovascular death, a 6% increase in major bleeding, and a 16% increase in minor bleeding. The odds of choosing no drug or old drug versus new drug were 0.72 (95% confidence interval, 0.61-0.84) and 0.86 (95% confidence interval, 0.81-0.93), respectively. Previous stroke or myocardial infarction was associated with membership in the class with larger negative preferences for these outcomes. CONCLUSIONS: Patients' preferences for various outcomes of anticoagulant therapy vary and depend on their previous experiences with myocardial infarction or stroke. Incorporating these preferences into benefit risk calculation and treatment decisions can enhance patient-centered care.
BACKGROUND: With proliferating treatment options for anticoagulant therapy, physicians and patients must choose among them based on their benefits and risks. Using a Discrete Choice Experiment, we elicited patients' relative preferences for specific benefits and risks of anticoagulant therapy. METHODS AND RESULTS: We selected a sample of US patients with cardiovascular disease from an online panel and elicited their preferences for benefits and risks of anticoagulant therapy: nonfatal stroke, nonfatal myocardial infarction, cardiovascular death, minor bleeding, major bleeding, bleeding death, and need for monitoring. These attributes were used to design scenarios describing hypothetical treatments that were labeled as new drug, old drug, or no drug. Latent class analysis was used to identify groups of patients with similar preferences. A total of 341 patients completed all Discrete Choice Experiment questions. On average, patients valued a 1% increased risk of a fatal bleeding event the same as a 2% increase in nonfatal myocardial infarction, a 3% increase in nonfatal stroke, a 3% increase in cardiovascular death, a 6% increase in major bleeding, and a 16% increase in minor bleeding. The odds of choosing no drug or old drug versus new drug were 0.72 (95% confidence interval, 0.61-0.84) and 0.86 (95% confidence interval, 0.81-0.93), respectively. Previous stroke or myocardial infarction was associated with membership in the class with larger negative preferences for these outcomes. CONCLUSIONS:Patients' preferences for various outcomes of anticoagulant therapy vary and depend on their previous experiences with myocardial infarction or stroke. Incorporating these preferences into benefit risk calculation and treatment decisions can enhance patient-centered care.
Authors: Marieke G M Weernink; Melissa C W Vaanholt; Catharina G M Groothuis-Oudshoorn; Clemens von Birgelen; Maarten J IJzerman; Janine A van Til Journal: Am J Cardiovasc Drugs Date: 2018-12 Impact factor: 3.571
Authors: Abdulla Shehab; Asim Ahmed Elnour; Akshaya Srikanth Bhagavathula; Pınar Erkekoglu; Farah Hamad; Saif Al Nuaimi; Ali Al Shamsi; Iman Mukhtar; AbdElrazek M Ali AbdElrazek; Aeshal Al Suwaidi; Mahmoud Abu Mandil; Mohamed Baraka; Adel Sadik; Khalid Saraan; Naama M S Al Kalbani; Alaa AbdulAziz Mahmood; Yazan Barqawi; Mohammed Al Hajjar; Omer Abdulla Shehab; Abdulla Al Amoodi; Sahar Asim; Rauda Abdulla; Cristina Sanches Giraud; El Mutasim Ahmed; Zohdi Abu Shaaban; Ahmed Eltayeb Yousif Ahmed Eltayeb Journal: J Saudi Heart Assoc Date: 2015-05-19