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.
Highlights
There is evidence suggesting that most thromboembolic complications could be prevented with adequate pharmacological anticoagulation
Six million Europeans are diagnosed with Atrial Fibrillation (AF), and it is estimated that this prevalence will double over the 50 years [5]
61.8% were classified as having international normalized ratio (INR) values “within the therapeutic range (TR)”
Summary
There 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. The prevalence of non-valvular atrial fibrillation (NVAF) increases with age, affecting 0.5% of the population aged 50–59 and almost 10% of those aged 80–89 [1]. The average age of patients with NVAF is 75, with a greater prevalence seen among women [1,2,3,4]. States (US) and the long-term cohert study in Rotterdam, the Netherlands report a one-in-four lifetime risk of developing Atrial Fibrillation (AF) for those over the age of 40 [2]. Six million Europeans are diagnosed with AF, and it is estimated that this prevalence will double over the 50 years [5]. The most common comorbidities seen in NVAF patients include arterial hypertension, diabetes mellitus, and previous ischemic heart disease
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