Preference and willingness-to-pay for novel oral anticoagulants in patients with atrial fibrillation – preliminary results from a two-centre survey in China

Abstract

OBJECTIVES : Non-vitamin K antagonist oral anticoagulants (NOACs) are effective alternatives to warfarin in stroke prophylaxis for patients with non-valvular atrial fibrillation (NVAF). However, underuse and discontinuation of NOACs remain common, especially in developing countries. We aimed to elicit patients’ preferences and willingness-to-pay (WTP) for anticoagulation therapy in China and to identify barriers in the uptake of NOACs. METHODS : We conducted a cross-sectional WTP survey in two public hospitals in Beijing and Shenzhen of Mainland China. Adults patients with a diagnosis of NVAF from specialist outpatient clinics or admitted to hospital were invited for a face-to-face interview. The questionnaire used discrete choice experiment with efficient design, in which seven treatment attributes were presented with different levels in nine hypothetical scenarios for the patient’s choice. Conditional logistic regression was used to estimate the regression coefficient and the marginal WTP. RESULTS : From January 1 to December 31 in 2018, we invited and obtained consent from 200 eligible patients for interview with 187 completed questionnaires collected (response rate: 93.5%; age: 69.3 years; female: 43.9%, inpatient: 70.6%). 51.3% of the patients had middle-level monthly income (CNY5001-12,000/month), and 94.1% were covered by the public or private insurance schemes. Commonly reported comorbidities included hypertension (n = 105, 56.1%), vascular diseases (n = 69, 36.9%) and diabetes (n = 57, 30.5%). Risk of acute myocardial infarction (AMI, odds ratio [OR] 1.35; 95% confidence interval (CI) 1.16-1.58), risk of bleeding (OR 0.90; 95% CI 0.86-0.94) and risk of ischemic stroke (OR 0.86; 95% CI 0.81-0.90) were the most important clinical attributes influencing the choice of oral anticoagulants. CONCLUSIONS : The preliminary results of this study showed that drug characteristic profiles were key determinants for treatment decision in anticoagulation. Further investigation is planned to estimate the overall WTP for NOACs and the role of social-demographic factors in the decision.