OBJECTIVES:

As the landscape of once-daily direct oral anticoagulants (DOACs)-based stroke prevention in atrial fibrillation (AF) evolves in Asia, treatment decisions become increasingly complex. The study quantified AF patient preferences for key characteristics of DOACs in China, Taiwan, and South Korea.

METHODS:

A predicted choice probability (PCP) analysis was conducted, weighting clinical data by preference data collected within a discrete choice experiment (DCE). DCE design was informed by a targeted literature review and workshop with clinical and methodological experts, and was refined through cognitive pilot interviews with 15 patients. Within the DCE, participants made 12 choices between two hypothetical unlabelled treatments and one fixed non-treatment option, each described by six attributes: risk of death, severe disability, mild or moderate disability, nondisabling events, intake with food and intake frequency. Different levels of these attributes were combined using a D-efficient design. Data were analyzed using mixed logit models. PCPs estimated the proportion of patients expected to choose one treatment over another.

RESULTS:

A total of 307 patients completed the DCE in China (155), Taiwan (75) and South Korea (76). Participants had been diagnosed with AF for 6 years on average. Reduction in the risk of death was the most important attribute, followed by reduction in risk of disabilities and non-disabling events. Intake with food and frequency were relatively less important compared with the clinical attributes. Based on the predicted uptake, patients generally preferred treatment profile associated with edoxaban (70.8% [SE: 2.4]) over rivaroxaban (29.2% [2.4]) overall.

CONCLUSIONS:

The multi-country preference study shows patients prioritize risk reduction in death and disability when selecting once-daily DOACs. Edoxaban was the favored once-daily DOAC over rivaroxaban among the patients in the PCP analyses. To guide shared decision-making, it's crucial to consider the distinct profiles of once-daily DOACs, ensuring the chosen option aligns with individual patient preferences.