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

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.