Patients' perspective in the decision and reimbursement process for direct-acting oral anticoagulants for atrial fibrillation and venous thromboembolic disease

Abstract

OBJECTIVE: To develop a method to incorporate practice-based knowledge of medical doctors, pharmacists, nurses and patients in treatment guidelines and in reimbursement decisions. DESIGN AND METHODS: Based on literature review and expert opinion of medical professionals a decision tree is developed for assessment of DOACs from patients' perspective in the treatment of non-valvular atrial fibrillation [nvAF] and venous thromboembolic disease (VTE). RESULTS: For both nvAF and VTE six relevant patient aspects were identified: target INR, safe use, therapy compliance, organisation of care, wellbeing and self-management. When comparing DOACs with standard VKA-containing treatment for these conditions, DOACs showed added value regarding four patient aspects in nvAF and five aspects in VTE. As an example, relevant aspects for DOACs are: easy dosage regimen, self-management of drug use and wellbeing. None of these aspects are represented in the current decision process for guidelines and reimbursement. CONCLUSION: Dealing with relevant criteria from a patients' perspective in a decision tree, DOACs have potential added value that should be considered in guideline development and reimbursement decisions.