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

Author

Listed:
  • Mehdi Najafzadeh

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Sebastian Schneeweiss

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Niteesh K. Choudhry

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Jerry Avorn

    (Brigham and Women’s Hospital, Harvard Medical School)

  • Joshua J. Gagne

    (Brigham and Women’s Hospital, Harvard Medical School)

Abstract

Objectives Preference weights derived from general population samples are often used for therapeutic decision making. In contrast, patients with cardiovascular disease may have different preferences concerning the benefits and risks of anticoagulant therapy. Using a discrete choice experiment, we compared preferences for anticoagulant treatment outcomes between the general population and patients with cardiovascular disease. Methods A sample of the general US population and a sample of patients with cardiovascular disease were selected from online panels. We used a discrete choice experiment questionnaire to elicit preferences in both populations concerning treatment benefits and risks. Seven attributes described hypothetical treatments: non-fatal stroke, non-fatal myocardial infarction, cardiovascular death, minor bleeding, major bleeding, fatal bleeding, and the need for monitoring. We measured preference weights and maximum acceptable risks in both populations. Results A total of 352 individuals from the general population and 341 patients completed the questionnaire. After propensity score matching, 284 from each group were included in the analysis. On average, the general population members valued a 1% increased risk of fatal bleeding as being the same as a 4.2% increase in a non-fatal myocardial infarction, a 2.8% increase in cardiovascular death, or a 14.1% increase in minor bleeding. Patients, in contrast, perceived a 1% increased risk of fatal bleeding as being the same as a 2.0% increase in a non-fatal myocardial infarction, a 3.2% increase in cardiovascular death, and a 16.7% increase in minor bleeding. Conclusions The general population and patients with cardiovascular disease had slightly different preferences for treatment outcomes. The differences can potentially influence estimated benefits and risks and patient-centered treatment decisions.

Suggested Citation

  • Mehdi Najafzadeh & Sebastian Schneeweiss & Niteesh K. Choudhry & Jerry Avorn & Joshua J. Gagne, 2019. "General Population vs. Patient Preferences in Anticoagulant Therapy: A Discrete Choice Experiment," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(2), pages 235-246, April.
    • Handle: RePEc:spr:patien:v:12:y:2019:i:2:d:10.1007_s40271-018-0329-1
    DOI: 10.1007/s40271-018-0329-1
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    References listed on IDEAS

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    1. Emily Lancsar & Jordan Louviere, 2006. "Deleting ‘irrational’ responses from discrete choice experiments: a case of investigating or imposing preferences?," Health Economics, John Wiley & Sons, Ltd., vol. 15(8), pages 797-811, August.
    2. F. Reed Johnson & Semra Özdemir & Carol Mansfield & Steven Hass & Corey A. Siegel & Bruce E. Sands, 2009. "Are Adult Patients More Tolerant of Treatment Risks Than Parents of Juvenile Patients?," Risk Analysis, John Wiley & Sons, vol. 29(1), pages 121-136, January.
    3. Victor Stango & Jonathan Zinman, 2009. "What Do Consumers Really Pay on Their Checking and Credit Card Accounts? Explicit, Implicit, and Avoidable Costs," American Economic Review, American Economic Association, vol. 99(2), pages 424-429, May.
    4. Fredrik Andersson & Carl Hampus Lyttkens, 1999. "Preferences for equity in health behind a veil of ignorance," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 369-378, August.
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    Cited by:

    1. David J. Mott & Laura Ternent & Luke Vale, 2023. "Do preferences differ based on respondent experience of a health issue and its treatment? A case study using a public health intervention," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(3), pages 413-423, April.
    2. Vass, Caroline M. & Boeri, Marco & Poulos, Christine & Turner, Alex J., 2022. "Matching and weighting in stated preferences for health care," Journal of choice modelling, Elsevier, vol. 44(C).

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