Budget Impact Of The Introduction Of New Oral Anticoagulants (Noac) For No Valve Atrial Fibrillation (Nvaf) In Extremadura

Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.

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New oral anticoagulants in patients with atrial fibrillation

The Lancet ◽

10.1016/s0140-6736(14)61104-1 ◽

2014 ◽

Vol 384 (9937) ◽

pp. 24

Author(s):

Wim Opstelten ◽

Maureen van den Donk ◽

Ton Kuijpers ◽

Jako S Burgers

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

New Oral Anticoagulants

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Methods of kidney function assessment in non-valvular atrial fibrillation in the era of new oral anticoagulants

European Journal of Internal Medicine ◽

10.1016/j.ejim.2014.02.007 ◽

2014 ◽

Vol 25 (6) ◽

pp. e71-e72 ◽

Cited By ~ 2

Author(s):

José Manuel Andreu-Cayuelas ◽

Francisco Marín ◽

Pedro José Flores-Blanco ◽

Arcadio García Alberola ◽

Sergio Manzano-Fernández

Keyword(s):

Atrial Fibrillation ◽

Kidney Function ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Function Assessment

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Health State In Patients With Atrial Fibrillation On New Oral Anticoagulants As Assessed With The New Eq-5d-5l Questionnaire At Baseline And 12-Month Follow-Up: Prefer In Af Registry

Value in Health ◽

10.1016/j.jval.2014.08.1464 ◽

2014 ◽

Vol 17 (7) ◽

pp. A493 ◽

Cited By ~ 1

Author(s):

B. Brüggenjürgen ◽

T. Schliephacke ◽

H. Darius ◽

Caterina R. De ◽

Heuzey J.Y. Le ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Health State

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Abstract W P302: Assessment of a New Method of Warfarin Management vs the New Oral Anticoagulants and Conventional Warfarin Management in Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.wp302 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Henry I Bussey ◽

Edith Nutescu

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Target Range ◽

Regression Equations ◽

Major Event ◽

Cost Avoidance ◽

Study Results ◽

Event Rates ◽

The Impact

PURPOSE: To assess the impact of International Normalized Ratio (INR) self testing and online remote monitoring and management (STORM2) on clinical events and costs vs. traditional warfarin management and the new oral anticoagulants (NOACs) in atrial fibrillation (AF). METHODS: Seven STORM2 trials had a weighted mean INR time in the target range (TTR) of 77.2%. Thromboembolism (TE) and major bleeding (MB) rates at 30%, 45%, 55%, 65%, and 75% TTR were calculated using linear regression equations from a systematic review of 38 AF studies. MB = 10.104 - 0.120x[TTR], (p = 0.004) and TE = 8.313 - 0.098x[TTR], (p = 0.03). MB and TE rates were sub-divided based on the distribution in the NOAC trials. TTR-based mortality was calculated based on a 6%/yr rate multiplied by the adjusted relative risks from a data base analysis of approximately 38,000 AF patients. Projected event rates at 75% TTR, expressed as number per 1,000 patient-years, were compared to event rates at lower TTR ranges and to rates reported in the NOAC trials. Differences in major event rates were used to calculate cost avoidance. RESULTS: Projected event rates with STORM2 (TTR of 75%) when compared to “conventional ” TTR of 55% to 65% were 64% to 71% lower for MB, 47% to 64% lower for TE, and 47% to 57% lower for mortality. Compared to the NOAC study results, the projected rates were 48% to 70% lower for MB, 41% to 66% lower for TE, and 40% to 53% lower for mortality. Projected cost avoidance was $10.4 million vs. a TTR of < 30%, $2.2 million vs. a TTR of 65%; and from $1.4 to $3.1 million vs the NOACs. Costs of “other” MB and TE , drug costs, and monitoring costs were not included in the estimates. CONCLUSIONS: STORM2 management of warfarin is projected to produce a 50% or greater reduction in major event rates with a cost avoidance of $1.4 to $10.4 million per 1,000 patients per year. CLINICAL IMPLICATIONS: STORM2 management may transform the safety and efficacy of anticoagulation for the millions of people with AF while substantially reducing costs. These findings warrant randomized, prospective trials in AF and other indications for anticoagulation.

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