Patients satisfaction with warfarin and willingness to switch to dabigatran: a patient survey

Abstract

Warfarin is an anticoagulant medication that is challenging to manage. Dabigatran has been approved by the FDA for stroke and systemic embolism prevention in non-valvular atrial fibrillation as an alternative to warfarin. Dabigatran does not require routine monitoring, has an established dose, and lacks many of the drug, herbal, and food interactions that afflict warfarin. To evaluate patients' satisfaction with their current warfarin treatment and their opinion on switching to a newly marketed medication (dabigatran) through a brief survey. Two separate surveys were administered to (1) evaluate the patients' opinion of their warfarin therapy and (2) evaluate their thoughts on switching to a newer anticoagulant. Responses were recorded on a rating scale of 1-5; 1 being the least and 5 being the highest. Study was conducted at the Georgia Regents Health System (GRHS) pharmacy-based anticoagulation clinic. Two hundred sixty patients on warfarin treatment were enrolled. Patients expressed high satisfaction with warfarin treatment (4.7 ± 0.78). However, a vast majority of the patients were willing to switch to an agent that: requires less frequent follow-up visits (3.9 ± 1.35); lacks interaction with food and/or beverage (4.1 ± 1.25); is as efficacious as warfarin (3.7 ± 1.38). Patients expressed that out-of-pocket cost would be a major barrier to switch to this new medication (1.3 ± 0.58). Patients are satisfied with their warfarin treatment but willing to consider a new anticoagulant. Cost was highlighted as the most significant barrier. Efficacy, dietary freedom and less frequent visits are the major factors affecting the patients' decision.

Effect of Patient Characteristics, Knowledge and Satisfaction with Warfarin Therapy on Willingness to Switch to a New Oral Anticoagulant

“…Our survey findings were also consistent with results of several other studies in which examine patients preferences, warfarin or switch to alternative oral anticoagulants to warfarin [20]. A study in a similar patient population done by Elewa et al using the same Likert scale ranging from 1 to 5, showed high willingness to switch to an agent with less frequent follow up visits (mean score of 3.9), lacks interaction with food (mean score of 4.1) and was as efficacious as warfarin (mean score of 3.7).…”

“…The willingness to switch assessment was based on items obtained from a survey created by Elewa et al [20]. This instrument was selected because of the topic specificity in measuring willingness to switch to new anticoagulation medications and its prior use in a similar care setting.…”

Stroke prevention in patients with atrial fibrillation in France: comparative cost-effectiveness of new oral anticoagulants (apixaban, dabigatran, and rivaroxaban), warfarin, and aspirin

“…Similarly to the limitations above, as our analysis adopted a payer perspective we did not consider any potential societal disutility or costs related with the transition from a drug such as warfarin that has been widely used for decades, vs the NOACs that have only recently emerged; thus, lacking the confidence of experience that exists with warfarin. Whilst such consequences could have increased the ICERs, these would likely be offset by consideration of the societal impact of stroke and less constrained treatment in terms of intakes and monitoring 16,17 potential shifting preference in those less willing to accept novel anticoagulants 18 .…”

“…The Association's 2012 guidelines suggested that NOACs should be considered in place of adjusted dose VKA 10 . Despite this recommendation and improved clinical data observed in NOAC trials, patient surveys have demonstrated a reluctance in some patients to switch therapy from traditional warfarin [16][17][18] . This, alongside lack of evidence to support an argument in favor of a particular NOAC in the guidelines, suggests a gap in the evidence and a need for comparative assessment of the overall benefits associated with alternative OAC therapies 16 .…”

“…Despite this recommendation and improved clinical data observed in NOAC trials, patient surveys have demonstrated a reluctance in some patients to switch therapy from traditional warfarin [16][17][18] . This, alongside lack of evidence to support an argument in favor of a particular NOAC in the guidelines, suggests a gap in the evidence and a need for comparative assessment of the overall benefits associated with alternative OAC therapies 16 . An assessment of the cost-effectiveness of the various interventions for the prevention of stroke and systemic embolism (SE) in France has not been performed yet, and, given the existing burden of the AF complications for the French healthcare system, a comparison between currently available therapies for AF is needed.…”