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In Reply: We suspect that many physicians share the opinion of Drs Perret-Guillaume and Wahl that the utility of warfarin therapy that we used seemed too high, since physicians tend to be more averse to warfarin therapy than are patients with atrial fibrillation.¹ As physicians, we need to take care that our own preferences (or our personal desire to avoid monitoring warfarin) do not usurp our patients’ preferences.

Similarly, as researchers, we need to conduct studies that minimize interviewer bias. Thus, the 1996 study² elicited utilities for warfarin, aspirin, and stroke using a computer-aided utility assessment tool, U-Titer.³ U-Titer was used to standardize the description of warfarin therapy and to iteratively determine utilities on a quality-of-life scale ranging from 0 (tantamount to death) to 1 (ideal health). The mean utility of warfarin from the 70 participants was 0.987, the value that we used in the base case analysis in the . . . [Full Text of this Article]

Cara L. O’Brien, MD
Internal Medicine Residency Program
Duke University
Durham, NC

Brian F. Gage, MD, MSc
bgage@im.wustl.edu
Washington University School of Medicine
St Louis, Mo

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