Conjoint analysis en tratamientos con anticoagulantes orales. Réplica / Conjoint analysis in treatments with oral anticoagulants. Reply

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Preferencias por los tratamientos anticoagulantes orales para la prevención a medio y largo plazo del ictus en la fibrilación auricular no valvular / Preferences for oral anticoagulant treatment in the medium and long term prevention of stroke in non valvular atrial fibrillation

Introducción. Un 40% de los pacientes con anticoagulación oral no iniciaría el tratamiento con antagonistas de la vitamina K por la necesidad de controles periódicos y sus interferencias con la dieta y medicación concomitante. Objetivo. Analizar las preferencias de los pacientes con fibrilación auricular no valvular por anticoagulantes orales (AO) para la prevención del ictus. Pacientes y métodos. Estudio observacional, transversal, multicéntrico, de preferencias y disponibilidad a pagar: se definieron los atributos de los AO mediante revisión de la bibliografía, grupos focales y entrevistas semiestructuradas con médicos y pacientes. Posteriormente, se definieron escenarios que los pacientes ordenaron según sus preferencias. Se analizaron los datos de la muestra total y por conglomerados agrupados por sus preferencias. Resultados. Se definieron ocho escenarios basados en cinco atributos: eficacia, seguridad, dosis fija, necesidad de controles de la coagulación, e interacciones con la dieta y medicación. Se entrevistó a 295 pacientes ambulatorios (edad media: 71,76 ± 9,81 años) que recibían AO. El atributo preferido fue el ‘menor número de embolias/año’ (importancia: 30,15%), seguido de ‘dosis fija del AO’ (25,45%) y ‘menor número de hemorragias intracraneales anuales’ (21,57%). En la muestra se identificaron tres segmentos de población con preferencias diferentes. La máxima disponibilidad a pagar (media) por un AO fue 66,76 ± 54,64 euros mensuales. Conclusiones. Eficacia, dosis fija y seguridad son los atributos de los AO más valorados por los pacientes con fibrilación auricular no valvular. Estas preferencias deberían considerarse al instaurar o cambiar el tratamiento con AO para mejorar el cumplimiento y prevención en pacientes (AU)

Introduction. About 40% of patients who receive oral anticoagulation would not start treatment with vitamin K antagonists due to the regular control they require and their interference with the diet and other concomitant medications. Aim. To analyze the preferences of patients with non valvular atrial fibrillation for oral anticoagulants (OAs) for the stroke prevention. Patients and methods. Observational, multicentric study on preferences and maximum willingness to pay based on conjoint analysis: literature review, focus groups and semi-structured interviews with physicians and patients (n = 295) to define the attributes of OAs and their levels. Definition of scenarios that patients ordered according to their preferences. Clusters analysis to identify population groups by their preferences. Results. Eight scenarios were defined based on five attributes: efficacy, security, a fixed dose, need for coagulation controls and interactions with diet and medication. The most preferred attribute was the smaller number of embolisms in a year (importance: 30.15%) followed by the fixed dose of the OA (25.45%) and the smaller number of intracranial hemorrhage in a year (21.57%). Three clusters population were identified. The maximum amount patients’ were willingness to pay for the OA was 66.76 ± 54.64 euros (mean) per month. Conclusions. Efficacy and a fixed dose are the attributes of OA most valued by non valvular atrial fibrillation patients. There are groups of patients who differ in their preferences. This differences should be taken into account when deciding instauration or change on the OA treatment to ameliorate the accomplishment and prevention in this patients (AU)

[Preferences for oral anticoagulant treatment in the medium and long term prevention of stroke in non valvular atrial fibrillation]. / Preferencias por los tratamientos anticoagulantes orales para la prevencion a medio y largo plazo del ictus en la fibrilacion auricular no valvular.

INTRODUCTION: About 40% of patients who receive oral anticoagulation would not start treatment with vitamin K antagonists due to the regular control they require and their interference with the diet and other concomitant medications. AIM: To analyze the preferences of patients with non valvular atrial fibrillation for oral anticoagulants (OAs) for the stroke prevention. PATIENTS AND METHODS: Observational, multicentric study on preferences and maximum willingness to pay based on conjoint analysis: literature review, focus groups and semi-structured interviews with physicians and patients (n = 295) to define the attributes of OAs and their levels. Definition of scenarios that patients ordered according to their preferences. Clusters analysis to identify population groups by their preferences. RESULTS: Eight scenarios were defined based on five attributes: efficacy, security, a fixed dose, need for coagulation controls and interactions with diet and medication. The most preferred attribute was the smaller number of embolisms in a year (importance: 30.15%) followed by the fixed dose of the OA (25.45%) and the smaller number of intracranial hemorrhage in a year (21.57%). Three clusters population were identified. The maximum amount patients' were willingness to pay for the OA was 66.76 ± 54.64 euros (mean) per month. CONCLUSIONS: Efficacy and a fixed dose are the attributes of OA most valued by non valvular atrial fibrillation patients. There are groups of patients who differ in their preferences. This differences should be taken into account when deciding instauration or change on the OA treatment to ameliorate the accomplishment and prevention in this patients.