General Population vs. Patient Preferences in Anticoagulant Therapy: A Discrete Choice Experiment

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Patient-Reported Outcomes

Background:

• General population preferences often guide therapeutic decisions.
• Patients with cardiovascular disease may possess distinct risk-benefit preferences for anticoagulant therapy.

Purpose of the Study:

• To compare preference weights for anticoagulant treatment outcomes between the general US population and patients with cardiovascular disease.
• To assess how differing preferences influence patient-centered treatment decisions.

Main Methods:

• A discrete choice experiment was employed with online panels from the general US population and cardiovascular disease patients.
• Seven attributes of hypothetical anticoagulant treatments were evaluated: stroke, myocardial infarction, cardiovascular death, minor bleeding, major bleeding, fatal bleeding, and monitoring needs.
• Preference weights and maximum acceptable risks were measured and compared between the two groups.

Main Results:

• General population: 1% fatal bleeding risk equivalent to 4.2% non-fatal myocardial infarction, 2.8% cardiovascular death, or 14.1% minor bleeding.
• Cardiovascular disease patients: 1% fatal bleeding risk equivalent to 2.0% non-fatal myocardial infarction, 3.2% cardiovascular death, or 16.7% minor bleeding.
• Propensity score matching ensured comparable analysis groups (n=284 each).

Conclusions:

• Significant differences exist in how the general population and cardiovascular disease patients perceive risks and benefits of anticoagulant therapy.
• These divergent preferences can impact the estimation of treatment benefits and risks.
• Acknowledging these distinct preferences is crucial for informed, patient-centered decision-making in anticoagulant therapy.