Patient-Reported Treatment Satisfaction with Dabigatran versus Warfarin in Patients with Non-Valvular Atrial Fibrillation in China

Abstract

Background Anti-coagulant therapy satisfaction for patients with atrial fibrillation is a critical issue, which impacts on their treatment adherence and clinical outcomes. The disadvantages of long-term warfarin treatment are well-described, and novel oral anti-coagulants have become an alternative option. Materials and Methods We compared patient-reported treatment satisfaction with dabigatran versus warfarin in non-valvular atrial fibrillation (NVAF) patients in China. Treatment satisfaction was assessed using the Anti-Clot Treatment Scale (ACTS) questionnaire, which included a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale. Results Among 834 patients, 246 patients (29.5%) were taking dabigatran and the others were on warfarin. Propensity score matching was employed to identify 182 patient pairs with balanced baseline characteristics. The global ACTS Burdens score and the global ACTS Benefits score were comparable between the dabigatran and warfarin groups (44.86 ± 3.95 vs. 44.28 ± 3.51, p = 0.423; 11.49 ± 2.92 vs. 11.42 ± 3.03, p = 0.194, respectively). The monthly cost of dabigatran was significantly higher compared with that of warfarin due to a lack of insurance coverage (USD 176.78 ± 9.15 vs. USD 2.49 ± 0.76, p = 0.000). The discontinuation rate of dabigatran was significantly higher than warfarin at the 6-month follow-up (33.5% vs. 19.2%, p = 0.003). Adjusted logistic regression showed that dabigatran was associated with a significant greater odds of non-persistence (odds ratio: 2.13, 95% confidence interval: 1.27–3.59, p = 0.004). Conclusion Dabigatran therapy in patients with NVAF in China associated with no improvement in satisfaction and a higher discontinuation rate compared with warfarin therapy largely due to increased economic burden.

A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

“…Compared with warfarin, NOACs are more convenient to use, including advantages such as fixed dose regimens, no requirement for frequent blood monitoring, no food and drug restrictions and less risk of bleeding 26 27. In the current study, we found that there was a substantially increased use of NOACs in Chinese patients during the past few years.…”

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

“…The use of a therapy associated with higher satisfaction is a critical issue, due to its relationship to treatment adherence, 55,56 associated better anticoagulation control, 46 and consequently improved health outcomes. 49,57 Moreover, optimal adherence is essential to ensure both efficacy and safety with anticoagulant therapy and adherence to OACs remains a challenge in clinical practice. 3,5,13 A recent study that assessed 12-month adherence and persistence with OACs reported adherence rates of 63.1 to 66.5% with NOACs, compared with 55.2% with VKAs, and persistence with NOACs of 61.4 to 78.7%, compared with 65.9% with VKAs.…”

“…14,33,[44][45][46][47] Additionally, in some studies the outcome was assessed by nonblinded interviewers. 40,41,43,48,49 Moreover, in three studies there may be bias regarding the patients lost to follow-up. 33,42,44 Almost all of the trials included patients who had been on the same oral anticoagulant for at least 3 months, with two exceptions.…”

Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

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