CC BY-NC-ND 4.0 · Thromb Haemost 2021; 121(02): 206-215
DOI: 10.1055/s-0040-1714739
Stroke, Systemic or Venous Thromboembolism

Anticoagulation Treatment in Cancer-Associated Venous Thromboembolism: Assessment of Patient Preferences Using a Discrete Choice Experiment (COSIMO Study)

Nils Picker
1  Real World and Advanced Analytics, Ingress-Health HWM GmbH, Wismar, Germany
Agnes Y. Lee
2  Department of Medicine, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada
3  Division of Hematology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
Alexander T. Cohen
4  Department of Hematological Medicine, Guys and St Thomas/NHS Foundation Trust, London, United Kingdom
Anthony Maraveyas
5  Division of Cancer, University of Hull, Hull, United Kingdom
Jan Beyer-Westendorf
6  Kings Thrombosis Service, Kings College London, London, United Kingdom
7  Thrombosis Research Unit, University Hospital “Carl Gustav Carus,” Dresden, Germany
Lorenzo G. Mantovani
8  Research Centre on Public Health (CESP), University of Milano-Bicocca, Milan, Italy
9  Value-Based Healthcare Unit, IRCCS Multimedica, Sesto San Giovanni, Italy
Khaled Abdelgawwad
10  Global Medical Affairs, Bayer AG, Germany
Samuel Fatoba
10  Global Medical Affairs, Bayer AG, Germany
Inga-Marion Thate-Waschke
11  Medical Affairs, Bayer Vital, Germany
Miriam Bach
10  Global Medical Affairs, Bayer AG, Germany
Thomas Wilke
1  Real World and Advanced Analytics, Ingress-Health HWM GmbH, Wismar, Germany
› Author Affiliations
Funding This study was funded by Bayer AG. This work has been supported by the Italian Ministry of Health Ricerca Corrente - IRCCS MultiMedica.


Introduction Clinical guidelines recommend anticoagulation therapy for the treatment of cancer-associated venous thromboembolism (VTE), but little is known about preferences. Therefore, the objective of this discrete choice experiment (DCE) was to elucidate patient preferences regarding anticoagulation convenience attributes.

Methods Adult patients with cancer-associated VTE who switched to direct oral anticoagulants were included in a single-arm study (COSIMO). Patients were asked to decide between hypothetical treatment options based on a combination of the following attributes: route of administration (injection/tablet), frequency of intake (once/twice daily), need for regular controls of the international normalized ratio (INR) at least every 3 to 4 weeks (yes/no), interactions with food/alcohol (yes/no), and distance to treating physician (1 vs. 20 km) as an additional neutral attribute. DCE data were collected by structured telephone interviews and analyzed based on a conditional logit regression.

Results Overall, 163 patients (mean age 63.7 years, 49.1% female) were included. They strongly preferred oral administration compared with self-injections (importance of this attribute for overall treatment decisions: 73.8%), and a treatment without dietary restrictions (11.8%). Even if these attributes were less important (7.2% and 6.5%, respectively), patients indicated a preference for a shorter distance to the treating physician and once-daily dosing compared with twice-daily intake. “Need for regular controls of INR at least every 3 to 4 weeks” showed no significant impact on the treatment decision (0.7%).

Conclusion This study showed that treatment-related decision making in cancer-associated VTE, assuming comparable effectiveness and safety of anticoagulant treatments, is predominantly driven by “route of administration,” with patients strongly preferring oral administration.

Authors' Contributions

The authors are solely responsible for the design and conduct of this study: all study analyses, the drafting and editing of the manuscript, and its final contents. All authors read and approved the final manuscript.

Supplementary Material

Publication History

Received: 23 March 2020

Accepted: 25 June 2020

Publication Date:
02 September 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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