OBJECTIVES:

Adherence to oral anticoagulant therapy (OAC) is of great importance to patients suffering from non-valvular atrial fibrillation to reduce the risk of stroke (AF). The objective of this study was to elicit patient preferences for convenience of OAC therapy, patient perception of the effect of convenience on medication adherence and estimate willingness-to-pay for improved convenience.

METHODS:

The attributes of OAC were identified using literature review, patient focus groups, and expert consultation. An online survey was distributed in five European countries among patients with AF who were taking OACs. Preferences for drug convenience (intake frequency; need for routine monitoring of coagulation; diet and/or drug interactions; pill intake; and pill type) were elicited using a discrete choice experiment. Additionally, patient’s current adherence, adherence to their preferred scenario and their willingness-to-pay for the most convenient scenario were elicited. Descriptive data analysis, Chi squared-test, independent t-test, and mixed logit analysis were used to analyse the data.

RESULTS:

The respondent sample consisted of 508 patients with AF. No need for routine monitoring had the highest impact on the perceived value of OACs (38.1%), while type of pill had the lowest impact (5.8%). Lower intake frequency (OR=1.26, p<0.001) and no need for routine monitoring (OR=1.04, p=0.013) were significant predictors of higher stated adherence to OAC, and the impact of drug convenience was larger in less adherent patients. The majority of patients (84.1%) were willing to switch from their current drug to a more convenient OAC and 45.5% were willing to pay additional co-pay (median of €23/month) for a more convenient therapy.

CONCLUSIONS:

Patients prefer a once-daily OAC which can be taken anytime, has limited drug/food interactions and does not require routine monitoring of coagulation. This study suggests that once instead of twice daily intake frequency and omitting the need for routine monitoring medication could improve adherence.