Document Detail


Patients' Preferences in Anticoagulant Therapy: Discrete Choice Experiment.
MedLine Citation:
PMID:  25387782     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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:
Mehdi Najafzadeh; Joshua J Gagne; Niteesh K Choudhry; Jennifer M Polinski; Jerry Avorn; Sebastian S Schneeweiss
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-11
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  -     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-12     Completed Date:  -     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 American Heart Association, Inc.
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