Modeling the Cost-Effectiveness of Prothrombin Complex Concentrate Compared With Fresh Frozen Plasma in Emergency Warfarin Reversal in the United Kingdom

Abstract

Background Warfarin is the most commonly used oral anticoagulant in the United Kingdom. Indications for its long-term use include recurrent venous throm-bosis, prosthetic heart valves, stroke prevention in atrial fibrillation, valvular heart disease, and prosthetic heart valve replacement. Objective The aim of this study was to estimate the cost-effectiveness of using prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for emergency warfarin reversal in patients with a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. Methods Mortality estimates associated with managing an intracranial, gastrointestinal, or retroperitoneal hemorrhage were obtained from published studies after a systematic literature search. Estimates of health care resource use pertaining to managing warfarin-treated patients after a life-threatening hemorrhage were provided by 11 consultant physicians with experience in warfarin reversal. These published clinical outcomes and clinician-derived health care resource use estimates were used to construct a decision model depicting the treatment patterns and associated resource use attributable to current management of a hypothetical cohort of adults undergoing emergency warfarin reversal as a result of an intracranial, gastrointestinal, or retroperitoneal hemorrhage in the United Kingdom. The model only considered direct health care costs borne by the secondary care sector of the National Health Service, and not those borne in the community (with the exception of the cost of stroke rehabilitation) and estimated the cost effectiveness of using PCC compared with FFP to reverse the anticoagulant effects of warfarin, from the perspective of the National Health Service, at 2007–2008 prices. Results The cost of warfarin reversal was estimated to be ≤15% of the total cost of managing a patient after a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. The cost per life-year gained with PCC was estimated to range from £1000 to £2000, depending on hemorrhage type (ie, intracranial, gastrointestinal, or retroperitoneal). The cost per quality-adjusted life-year gained with PCC was estimated at £3000 or less depending on hemorrhage type. Conclusion PCC appeared to be a more cost-effective treatment than FFP for the emergency reversal of warfarin, from the perspective of the UK National Health Service, in this model analysis.