(P-118) Understanding Oral Anticoagulant Preferences of Patients with Atrial Fibrillation in China and Willingness-to-pay: Evidence from a Discrete Choice Experiment

Background: Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) in China is lower than warfarin. Patient preference, one of the main reasons for NOACs cessation, is an unfamiliar concept in China.

Objectives: To investigate of preferences and willingness to pay (WTP) for anticoagulation therapy among patients with AF in China.

Methods: A discrete choice experiment was conducted to quantify patient preference on 7 attributes of oral anticoagulant: antidote (yes/no), food-drug interaction (yes/no), frequency of blood monitoring (no need, every 6/3/1 month[s]), risks of non-fatal major bleeding (0.7/3.1/5.5/7.8[%]), non-fatal stroke (ischemic/hemorrhagic) or systemic embolism (0.6/3.2/5.8/8.4[%]), and non-fatal acute myocardial infarction (AMI) (0.2/1.0/1.8/2.5[%]), and monthly out-of-pocket cost (0/120/240/360 RMB) (0-56 USD). Sixteen scenarios were generated by using D-Efficient design and were randomly divided into 2 blocks. Eligible patients were recruited and interviewed from outpatient and inpatient settings of two public hospitals in Beijing and Shenzhen respectively. Two unlabeled hypothetical treatments and one opt-out option were chosen by patients. Mixed logit regression model was used for estimating patients’ preferences of and willingness-to-pay for NOAC.

Results: A total of 506 patients were recruited between May 2018 and December 2019 (mean age 70.3, 42.1% women). Patients were mainly concerned about the risks of AMI (β: -1.03; 95%CI: -1.31, -0.75), stroke or systemic embolism (β: -0.81; 95%CI: -0.90, -0.73) and major bleeding (β: -0.69; 95%CI: -0.78, -0.60), and were willing to pay more, from up to 798 RMB to 536 RMB (124 to 83 USD) monthly. The least concerning attribute was frequency of blood monitoring (β: -0.31; 95%CI: -0.39, -0.24). Patients had more concerns about food-drug interaction even exceeding preferences on the 3 risks, if they had a history of stroke or bleeding (β: -2.47; 95%CI: -3.92, -1.02), recruited from Beijing (β: -1.82; 95%CI: -2.56, -1.07), or male (β: -0.96; 95%CI: -1.36, -0.56). Patients with lower educational attainment or lower income weighted all attributes lower, and their willingness-to-pay for incremental efficacy and safety were minimal.

Conclusions: Patients with AF in China were mainly concerned about the safety and effectiveness of oral anticoagulation therapy. The preference weighting on food-drug interaction varied widely. Patients with lower educational attainment or income levels and less experience of bleeding or stroke had more reservations about paying for better treatment.