Abstract 150: Antithrombotic Use in Nonvalvular Atrial Fibrillation (NVAF): Alignment between Guidelines and Emerging Evidence with Clinician Prescribing Preferences

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Jason Shafrin ◽  
Amanda Bruno ◽  
Joanna P MacEwan ◽  
Avrita Campinha-Bacote ◽  
Jeffrey Trocio ◽  
...  
Keyword(s):  
Willingness To Pay ◽  
Risk Reduction ◽  
Online Survey ◽  
Stroke Risk ◽  
Treatment Guidelines ◽  
Bleeding Risk ◽  
Treatment Comparison ◽  
Dosing Frequency ◽  
Indirect Treatment ◽  
Treatment Comparisons

Background: 2014 AHA/ACC/HRS guidelines recommend anticoagulation for NVAF patients with a CHA2DS2-VASc≥2, but do not endorse a specific therapy. Several published indirect treatment comparisons demonstrate similar stroke risk reduction but distinct differences for bleeding risk among novel oral anticoagulants (NOACs) in NVAF patients. Objectives: Survey physicians to determine how their preferences over antithrombotic therapies compare with current treatment guidelines and indirect treatment comparisons. Methods: An online survey was completed by 200 physicians who regularly treat patients with NVAF. Respondents answered 12 questions comparing two hypothetical antithrombotic treatments that varied across five attributes: stroke risk, major bleeding risk, inconvenience (i.e., regular INR blood-testing/dietary restrictions), dosing frequency and patient out-of-pocket (OOP) cost. Physician willingness to trade higher OOP cost for improvements in other attributes was estimated using a logistic regression. Based on these results, we calculated the share of prescriptions that would be written for apixaban, aspirin, dabigatran, rivaroxaban and warfarin using real-world US patient OOP costs. Results: Physicians were willing to trade an increase in monthly OOP cost of $38.21 (95% CI: $22.07-$54.34) for a 1 percentage point (absolute) decrease in annual stroke risk. Physicians also placed a positive value on less inconvenience ($34.46, 95% CI: $8.50-$60.41), and a 1 percentage point reduction in the risk of a major bleed ($14.44, 95% CI: $8.01-$20.88). Physicians did not have a significant willingness to pay to reduce dosing frequency from twice to once per day ($17.16; 95% CI: -0.08-$34.40). Cardiologists and cardiac electrophysiologists had higher willingness to pay for stroke risk reduction than general practitioners ($54.32 vs. $24.74, p<0.001). Based on these preferences, physicians would recommend NOACs to 77% of patients, with apixaban (32%) being the preferred NOAC. Conclusions: Similar to findings from indirect treatment comparison studies, physicians largely prefer NOACs_particularly apixaban_compared to warfarin or aspirin for stroke risk reduction in NVAF patients. Additional research is needed to determine why NOACs are underused in practice.

scholarly journals Consumer Preferences and Willingness to Pay for Potting Mix with Biochar

Energies ◽  
2021 ◽  
Vol 14 (12) ◽  
pp. 3432
Author(s):  
McKenzie Thomas ◽  
Kimberly L. Jensen ◽  
Dayton M. Lambert ◽  
Burton C. English ◽  
Christopher D. Clark ◽  
...  
Keyword(s):  
Willingness To Pay ◽  
Online Survey ◽  
Product Information ◽  
Consumer Preferences ◽  
Market Potential ◽  
Marginal Costs ◽  
Consumer Demographics ◽  
Market Shares ◽  
Potential Market ◽  
Dedicated Energy Crops

Biochar is a co-product of advanced biofuels production from feedstocks including food, agricultural, wood wastes, or dedicated energy crops. Markets for soil amendments using biochar are emerging, but little is known about consumer preferences and willingness to pay (WTP) for these products or the depth of the products’ market potential for this product. This research provides WTP estimates for potting mix amended with 25% biochar, conditioned on consumer demographics and attitudes about product information labeling. Data were collected with an online survey of 577 Tennessee home gardeners. WTP was elicited through a referendum contingent valuation. Consumer WTP for an 8.81 L bag of 25% biochar potting mix is $8.52; a premium of $3.53 over conventional potting mix. Demographics and attitudes toward biofuels and the environment influence WTP. Biochar amounts demanded are projected for the study area’s potential market. Optimal prices, profits, and market shares are estimated across different marginal costs of producing biochar potting mix.

scholarly journals Cost-effectiveness of empagliflozin in patients with type 2 diabetes and established cardiovascular disease in China

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mafalda Ramos ◽  
Peng Men ◽  
Xu Wang ◽  
Anastasia Ustyugova ◽  
Mark Lamotte
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Treatment Effects ◽  
Specific Treatment ◽  
Treatment Comparison

Abstract Background In several cardiovascular outcome trials (CVOTs), empagliflozin (SGLT-2 inhibitor), sitagliptin (DPP-4 inhibitor) and liraglutide (GLP-1 receptor agonist) + standard of care (SoC) were compared to SoC in patients with type 2 diabetes and established cardiovascular disease (CVD). This study assessed the cost-effectiveness (CE) of empagliflozin + SoC in comparison to sitagliptin + SoC and liraglutide + SoC based on the respective CVOT. Methods The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the CVOT outcomes. EMPA-REG OUTCOME baseline characteristics and CVOT specific treatment effects on risk factors for cardiovascular disease (HbA1c, BMI, blood pressure, lipids) were applied. Three-year observed cardiovascular events of empagliflozin + SoC versus sitagliptin + SoC and liraglutide + SoC were derived from EMPA-REG OUTCOME and an indirect treatment comparison. Relative risk adjustments to calibrate the CDM were obtained after a trial and error process to match as closely the observed and CDM-predicted outcomes. The drug-specific treatment effects were considered up until HbA1c reached 8.5% and treatment switch occurred. After this switch, the United Kingdom Prospective Diabetes Study 82 risk equations predicted events based on co-existing risk factors and treatment intensification to basal bolus insulin were applied. The analysis was conducted from the perspective of the Chinese healthcare system applying 3% discounting. The time horizon was lifelong. Results Empagliflozin + SoC provides additional Quality Adjusted Life years (QALY + 0.564) for an incremental cost of 42,497RMB (US$6053) compared to sitagliptin + SoC, resulting in an Incremental Cost Utility Ratio of 75,349RMB (US$10,732), thus below the willingness-to-pay threshold of 212,676RMB, corresponding to three times the Gross Domestic Product in China (2019). Compared to liraglutide + SoC, empagliflozin + SoC use leads to 0.211QALY gained and cost savings of 71,427RMB (US$10,173) and is as such dominant. Scenario and probabilistic sensitivity analyses demonstrated the robustness of the results. Conclusion Results suggest that empagliflozin + SoC is cost-effective compared to sitagliptin + SoC and liraglutide + SoC at a willingness-to-pay threshold of 212,676RMB ($30,292)/QALY.

scholarly journals An indirect treatment comparison of the efficacy of semaglutide 1.0 mg versus dulaglutide 3.0 mg and 4.5 mg

2021 ◽  
Author(s):  
Richard E. Pratley ◽  
Andrei‐Mircea Catarig ◽  
Ildiko Lingvay ◽  
Adie Viljoen ◽  
Abby Paine ◽  
...  
Keyword(s):  
Indirect Treatment Comparison ◽  
Treatment Comparison ◽  
Indirect Treatment
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