Patient-reported health preferences of anticoagulant-related outcomes

Abstract

Strokes can have a catastrophic impact on patients' health-related quality of life (HRQoL). In addition to warfarin, two novel oral anticoagulants, i.e., dabigatran and rivaroxaban, have been approved to prevent strokes. This study aimed to use direct measures to elicit patient-reported utilities (i.e., preferences) for anticoagulant-related outcomes. A cross-sectional survey was administered to 100 patients taking warfarin in an anticoagulation clinic. Utilities for six long-term and four short-term anticoagulant-related health states were elicited by the visual analogue scale (VAS) and standard gamble (SG) methods. Health states with the highest SG-derived mean utility values were "well on rivaroxaban" (mean ± SD = 0.90 ± 0.15), "well on warfarin" (0.86 ± 0.17), and "well on dabigatran" (0.83 ± 0.18). Approximately half of the patients considered major ischemic stroke (-1.57 ± 6.77) and intracranial hemorrhage (-1.99 ± 6.98) to be worse than death. The percentages of patients who considered a particular health state worse than death ranged from 0 to 55 % among various health states assessed. The VAS had similar findings. Good logical consistency was observed in both VAS- and SG-derived utility values. Ischemic stroke and intracranial hemorrhage had a significant impact on patients' HRQoL. Greater variation in patients' preferences was observed for more severely impaired health states, indicating the need for individualized medical decision-making. In this study, both long-term and short-term health states were included in the utility assessment. The findings of this study can be used in cost-utility analysis of future anticoagulation therapies.

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

“…2) [18, 40–49]. Three of these could be characterised as multicentre studies ensuring a representative inclusion of patients and applying a methodology that addressed most of the known differences between VKAs and NOACs (mean number of patients 426) [40–42].…”

“…Finally, three single-centre studies including a convenience sample of AF patients (100 % OAC users; mean number of patients 118) mostly used a standard gamble/trade-off technique (two studies), while one study used a preference questionnaire [47–49]. None of these studies addressed all known differences between NOAC or VKA treatment.…”

Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism: Executive Summary of a European and Asia-Pacific Expert Consensus Paper

“…96,113-117 Among cancer patients, risk of bleeding was less important than ensuring that VTE prophylaxis did not interfere with cancer treatment and OAC efficacy. 118,119 Studies assessing patient preferences toward VKAs versus NOACs 105, [120][121][122][123][124][125][126][127][128][129] indicate that when efficacy and safety are similar, patients with AF and VTE commonly favored simpler, more convenient treatment regimens, less frequent dosing, fixed-dose medication, without need for regular monitoring or bridging, or drug-food interactions. 103,111,112,117,121,[130][131][132][133][134][135]…”

A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants

“…HRQoL was reported in 5 studies and used the Euro-QoL utility and visual analogue scores, which covered 5 dimensions (consisting of mobility, autonomy, usual activities, pain/discomfort, anxiety/ depression) or the Sawicki questionnaire (which is a 32-item questionnaire grouped covering general treatment satisfaction, self-efficacy, strained social network, daily hassles and distress). 14,46,47 The majority of the studies (14 studies) described: patient-reported treatment satisfaction, which had been measured using the ACTS (a 15-point scale to score burden and benefit); or treatment satisfaction questionnaire for medication (TSQM) version II, which assesses 4 subscales of on Likert scales) 15,16 ; and medication-related, review or interventionrelated, and adverse outcomes. Overall, the outcomes were diverse with differing definitions, methods of data collection, varying time points and different reporting methods.…”

“…13 HRQoL can be defined as an evaluation of impairment, disability or handicap. 12,14 Patient satisfaction determines perceived burden or benefits of the perceived treatment being appraised. 12 The Anti-Clot Treatment Scale (ACTS), Treatment Satisfaction Questionnaire for Medication (TSQM) and Perception of Anticoagulation Questionnaire (PACT) are tools used to assess satisfaction.…”