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Published on: February 28, 2012
Factors influencing doctors' selection of dabigatran in non-valvular atrial fibrillation
Cindy Huang1, Michele Siu, Lily Vu
1Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
Insights
Cost is the primary driver for dabigatran prescription decisions. Factors like renal function and patient history also influence choices, with cardiologists showing greater comfort prescribing dabigatran than internists.
Area of Science:
- Pharmacology and Therapeutics
- Clinical Decision Making
Background:
- Warfarin has been a standard anticoagulant, but newer direct oral anticoagulants (DOACs) like dabigatran offer alternatives.
- Understanding physician prescribing patterns for dabigatran is crucial for optimizing anticoagulation therapy.
Purpose of the Study:
- To investigate the key factors influencing physicians' decisions to initiate or switch anticoagulation therapy from warfarin to dabigatran.
- To compare the prescribing habits and comfort levels of cardiologists and general internists regarding dabigatran.
Main Methods:
- A survey of 181 physicians (cardiologists and general internists) at UCSF Medical Center was conducted.
- The survey comprised 17 multiple-choice questions assessing factors for dabigatran initiation/switching.
- Statistical analyses included Fisher's exact test and Cochran-Mantel-Haenszel test.
Main Results:
- A 35.9% response rate yielded 65 completed surveys (13 cardiologists, 51 general internists).
- For warfarin-naïve patients, cost (25%), renal function (21%), and CHADS2 score (18%) were key factors for dabigatran eligibility.
- For patients on warfarin, unstable INR (37%), missed appointments (17%), and cost (19%) were primary considerations.
Conclusions:
- Physician decisions regarding dabigatran are significantly influenced by cost, alongside safety, effectiveness, and patient preference.
- Cardiologists demonstrated higher prescribing frequency and comfort with dabigatran compared to general internists (77% vs. 27%).
- General internists reported lower comfort levels with dabigatran prescribing than their cardiology counterparts.
Rationale, Aims And Objectives:
This study was designed to examine the factors that influence doctors' decision in initiating or switching from warfarin to dabigratran.
Method:
A survey questionnaire was sent to 181 doctors who were most likely to prescribe dabigatran (e.g. cardiologists and general internists) at the University of California, San Francisco Medical Center between November 2011 and February 2012. Survey participants were asked to complete an electronic or a paper version of the questionnaire, which consisted of 17 multiple-choice questions. Fisher's exact test and Cochran-Mantel-Haenszel test were used to compare survey responses between cardiologists and general internists.
Results:
A total of 65 survey responses were received (35.9% response rate). There were 13 cardiologists and 51 general internists who participated in the study. Cost (25%), renal function (21%) and CHADS2 score (18%) were the three factors doctors considered most often to determine a patient's eligibility for dabigatran in warfarin-naïve patients. On the other hand, histories of unstable international normalized ratio (37%) and missed appointments (17%) along with cost (19%) were most often considered in patients on warfarin. Cardiologists had prescribed dabigatran more often and had a significantly higher level of comfort with prescribing the drug than general internists (P = 0.003; 77% vs. 27%).
Conclusions:
Cost was the most important factor influencing doctors' decision to prescribe dabigatran. Safety and effectiveness of dabigatran as well as patient preference were additional factors influencing their decision. General internists were less comfortable with prescribing dabigatran than cardiologists.
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