Direct vitamin k antagonist anticoagulant treatment health care costs in patients with non-valvular atrial fibrillation

Abstract

BackgroundThere is evidence suggesting that most thromboembolic complications could be prevented with adequate pharmacological anticoagulation. We estimated the direct health care costs of anticoagulant treatment with oral vitamin K antagonists in patients diagnosed with non-valvular atrial fibrillation.MethodsThis observational study examined the clinical records of patients diagnosed with non-valvular atrial fibrillation who received anticoagulant treatment with oral vitamin K antagonists. Data from clinical records were used in the study: international normalized ratio, number of monitoring visits, type of anticoagulant, hospital admissions from complications, and concomitant medication. Drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the Diagnosis Related Group price for each case. Hospital visits costs were calculated by one of four different scenarios, using either the invoice rates for the regional health care authority or cost per visit as established by analytical accounting methods.ResultsWe collected data from 1,257 patients diagnosed with non-valvular atrial fibrillation who were receiving oral anticoagulant therapy. Depending on the scheme used, the direct health care costs for these patients ranged from €423,695 - €1,436,038 per annum. The average cost per patient varied between €392 - €1,341, depending on the approach used. Patients with international normalized ratio values within the therapeutic range on 25% of their visits represented an average cost between €441.70 - €1,592. Those within the therapeutic range on 25%–50% of visits had associated costs of €512.37 - €1,703.91. When international normalized ratio values were within the therapeutic range on 50% - 75% of the visits, the costs ranged between €400.80- €1,375.74. The average cost was €305.23 - €1,049.84 when the values were within the therapeutic range for over 75% of visits.ConclusionsMost direct health care costs associated with the sampled patients arise from the specialist-care monitoring required for the treatment. Good monitoring is inversely related to direct health care costs.

Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position

“…The direct cost of patients with mitral prosthesis is higher than patients with NVAF. Patients with prosthetic heart valves in the mitral position had a cost of €3825.04 per 5 years in our study (€1558.15 per year), which was much higher than the costs recorded by Hidalgo et al of €392 per year 17 and the €441 per year reported by Navarro et al 16 Therefore, these patients generate a higher cost to the National Health System than patients with NVAF because their management is complex and the risk of complications is higher. The decisive factor in the cost is monitoring visits that patients require as a result of their pathology, because the costs of medication and consumables are similar in both groups of patients.…”

“…This discrepancy may be partially due to the different invoicing model used in this study. The costs were also higher than those generated by patients with non-valvular atrial fibrillation (NVAF) in the study by Hidalgo-Vega et al 17 These results are consistent because patients with mitral prostheses are a more complex group that requires more accurate monitoring and develops worse complications related to OAT.…”

“…Regarding the direct costs of OAT-VKA, a study of a group of patients with NVAF in the UH-FJD estimated that the mean cost (including drug costs, INR monitoring, rescue medication and medical visits: hospital admissions for thrombotic or hemorrhagic complications) was between €392 and €1341 depending on the scenario of valuation applied. 17 Moreover, positive and significant correlations between costs and patients with poor INR control have been described. An analysis of the direct healthcare costs must reference one work that involved the major hospitals of the Spanish national health system in 2008 by Navarro et al, 16 because it is the only study that collected the cost of OAT-VKA in a disaggregated manner and also included patients with mitral prostheses.…”

Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA

“…No obstante, es interesante destacar que el protagonismo de atenció n primaria fue aú n mayor en el estudio PAULA. Este es un aspecto importante, ya que, aunque con algunas limitaciones metodoló gicas importantes, se ha señ alado que los costes podrían ser menores cuando el control de la INR se realiza desde el primer nivel asistencial 22 .…”

Effect of Renal Function on Dosing of Non–Vitamin K Antagonist Direct Oral Anticoagulants Among Patients With Nonvalvular Atrial Fibrillation

“…1 It is estimated that about 2.3 million people had NVAF in 2013 in the United States, and this is projected to increase to 5.6 million by 2050. 2 The rate of ischemic stroke among NVAF patients averages approximately 5% per year, 2 to 7 times the rate of those without NVAF. 3 Non-vitamin K antagonist direct oral anticoagulants (DOACs), including apixaban, rivaroxaban, and dabigatran, have emerged as important therapeutic treatment alternatives to warfarin for stroke prevention in NVAF patients since 2010.…”