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Patient-reported health preferences of anticoagulant-related outcomes

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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.

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References

  1. World Health Organization (2008) The top 10 causes of death. http://www.who.int/mediacentre/factsheets/fs310/en/index.html. Accessed 25 July 2013

  2. World Health Organization (2004) The global burden of disease. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed 25 July 2013

  3. DE Singer, Albers GW, Dalen JE, Go AS, Halperin JL, Manning WJ (2004) Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:429S–456S

    Article  CAS  PubMed  Google Scholar 

  4. Sorensen HT, Horvath-Puho E, Pedersen L, Baron JA, Prandoni P (2007) Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. Lancet 370:1773–1779

    Article  PubMed  Google Scholar 

  5. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E (2004) The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:204S–233S

    Article  CAS  PubMed  Google Scholar 

  6. Baber U, Mastoris I, Mehran R (2014) Balancing ischaemia and bleeding risks with novel oral anticoagulants. Nat Rev Cardiol 11:693–703

    Article  CAS  PubMed  Google Scholar 

  7. Drummond MF (2005) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, New York

    Google Scholar 

  8. von Neumann J, Morgenstern O (1944) Theory of games and economic behaviour, 1st edn. Princeton University Press, Princeton

    Google Scholar 

  9. Hallan S, Asberg A, Indredavik B, Wideroe TE (1999) Quality of life after cerebrovascular stroke: a systematic study of patients’ preferences for different functional outcomes. J Intern Med 246:309–316

    Article  CAS  PubMed  Google Scholar 

  10. Robinson A, Thomson R, Parkin D, Sudlow M, Eccles M (2001) How patients with atrial fibrillation value different health outcomes: a standard gamble study. J Health Serv Res Policy 6:92–98

    Article  CAS  PubMed  Google Scholar 

  11. Gage BF, Cardinalli AB, Owens DK (1996) The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med 156:1829–1836

    Article  CAS  PubMed  Google Scholar 

  12. Froberg DG, Kane RL (1989) Methodology for measuring health-state preferences–I: measurement strategies. J Clin Epidemiol 42:345–354

    Article  CAS  PubMed  Google Scholar 

  13. Furlong W, Feeny D, Torrance GW, Barr R, Horsman J (1990) Guide to design and development of health-state utility instrumentation. The McMaster University. http://www.chepa.org/Files/Working%20Papers/WP%2090-9.pdf. Accessed 3 Jan 2013

  14. Torrance GW (1986) Measurement of health state utilities for economic appraisal: a review. J Health Econ 5:1–30

    Article  CAS  PubMed  Google Scholar 

  15. Brazier J, Ratcliffe J, Salomon JA, Tsuchiya A (2007) Measuring and valuing health benefits for economic evaluation, 1st edn. Oxford University Press, New York

    Google Scholar 

  16. Froberg DG, Kane RL (1989) Methodology for measuring health-state preferences–III: population and context effects. J Clin Epidemiol 42:585–592

    Article  CAS  PubMed  Google Scholar 

  17. Gudex C (1994) Standard gamble user manual: props and self-completion methods. The University of York. http://www.york.ac.uk/media/che/documents/papers/occasionalpapers/CHE%20Occasional%20Paper%2021.pdf. Accessed 3 Jan 2013

  18. Samsa GP, Matchar DB, Goldstein L et al (1998) Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke. Am Heart J 136:703–713

    Article  CAS  PubMed  Google Scholar 

  19. Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC (1984) Preferences for health outcomes. Comparison of assessment methods. Med Decis Making 4:315–329

    Article  CAS  PubMed  Google Scholar 

  20. Shin AY, Porter PJ, Wallace MC, Naglie G (1997) Quality of life of stroke in younger individuals: utility assessment in patients with arteriovenous malformations. Stroke 28:2395–2399

    Article  CAS  PubMed  Google Scholar 

  21. Monz BU, Connolly SJ, Korhonen M et al (2013) Assessing the impact of dabigatran and warfarin on health-related quality of life: results from an RE-LY sub-study. Int J Cardiol 168:2540–2547

    Article  CAS  PubMed  Google Scholar 

  22. Chenaitia H, Lefevre O, Ho V et al (2013) Emergency medical service in the stroke chain of survival. Eur J Emerg Med 20:39–44

    Article  PubMed  Google Scholar 

  23. El Hachioui H, van de Sandt-Koenderman MW, Dippel DW, Koudstaal PJ, Visch-Brink EG (2011) A 3-year evolution of linguistic disorders in aphasia after stroke. Int J Rehabil Res 34:215–221

    Article  PubMed  Google Scholar 

  24. Post PN, Stiggelbout AM, Wakker PP (2001) The utility of health states after stroke: a systematic review of the literature. Stroke 32:1425–1429

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to acknowledge the National University of Singapore for providing us with a research Grant.

Conflict of interest

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Author information

Authors and Affiliations

  1. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ye Wang

  2. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

    Feng Xie

  3. Department of Pharmacy, Singapore General Hospital, Singapore, Singapore

    Ming Chai Kong

  4. Department of Hematology, Singapore General Hospital, Singapore, Singapore

    Lai Heng Lee & Heng Joo Ng

  5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Lai Heng Lee

  6. DUKE-National University of Singapore Graduate Medical School, Singapore, Singapore

    Lai Heng Lee

  7. School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 11031, Taiwan

    Yu Ko

Authors
  1. Ye Wang
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  2. Feng Xie
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  3. Ming Chai Kong
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  4. Lai Heng Lee
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  5. Heng Joo Ng
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  6. Yu Ko
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Corresponding author

Correspondence to Yu Ko.

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Wang, Y., Xie, F., Kong, M.C. et al. Patient-reported health preferences of anticoagulant-related outcomes. J Thromb Thrombolysis 40, 268–273 (2015). https://doi.org/10.1007/s11239-015-1191-9

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  • DOI: https://doi.org/10.1007/s11239-015-1191-9

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