Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies

Value Health. 2016 Jun;19(4):451-9. doi: 10.1016/j.jval.2016.01.001. Epub 2016 Mar 2.


Objectives: The objective of this study was to compare patient and physician preferences for different antithrombotic therapies used to treat nonvalvular atrial fibrillation (NVAF).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: anticoagulants; atrial fibrillation; discrete choice experiment; preferences; willingness to pay.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anticoagulants
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / economics*
  • Attitude of Health Personnel*
  • Attitude to Health
  • Choice Behavior
  • Costs and Cost Analysis
  • Female
  • Fibrinolytic Agents / economics*
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Preference / psychology
  • Patient Preference / statistics & numerical data*
  • Patients / psychology
  • Physicians / psychology*
  • Pilot Projects
  • Stroke / complications
  • Stroke / prevention & control
  • Surveys and Questionnaires
  • Warfarin / economics
  • Warfarin / therapeutic use
  • Young Adult


  • Anticoagulants
  • Fibrinolytic Agents
  • Warfarin