Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin

Mikko Pyykönen,Tiina Laatikainen,Miika Linna,Eric Delmelle,Markku Tykkyläinen

doi:10.1186/s12913-021-07125-5

Abstract

BackgroundAnticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies.MethodsThis retrospective study used individual-level patient data from 4000 atrial fibrillation (AF) patients from North Karelia, Finland. Real-world data on healthcare use was obtained from the regional patient information system and data on reimbursed travel costs from the database of the Social Insurance Institution of Finland. The costs of the therapies were estimated between June 2017 and May 2018. Using a Geographical Information System (GIS), we estimated travel time and costs for each journey related to anticoagulant therapies. We ultimately applied therapy and travel costs to a cost model to reflect real-world expenditures.ResultsThe costs of anticoagulant therapies were calculated from the standpoint of patient and the healthcare service when considering all costs from AF-related healthcare visits, including major complications arising from atrial fibrillation. On average, the annual cost per patient for healthcare in the form of public expenditure was higher when using DOAC therapy than warfarin therapy (average cost = € 927 vs. € 805). Additionally, the average annual cost for patients was also higher with DOAC therapy (average cost = € 406.5 vs. € 296.7). In warfarin therapy, patients had considerable more travel and time costs due the different implementation practices of therapies.ConclusionThe results indicated that DOAC therapy had higher costs over warfarin from the perspectives of the patient and healthcare service in the study area on average. Currently, the cost of the DOAC drug is the largest determinator of total therapy costs from both perspectives. Despite slightly higher costs, the patients on DOAC therapy experienced less AF-related complications during the study period.

Highlights

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide [1]
While AF diagnoses were not limited by any starting date, we only included those AF patients who had been on warfarin or direct oral anticoagulant (DOAC) therapy at least two months before the study period
The mode of taxi was mostly set based on Social Insurance Institution of Finland (Kela)’s database, but we considered the possibility of elderly people aged 90 years and older travelling by taxi short taxi trips under € 25 are not reimbursed and not all patients are eligible for the travel reimbursement (Table 1)

Summary

Introduction

In Europe and the USA, it is expected that one in four middle-aged adults will be diagnosed in their lifetime [2]. The number of patients is expected to rise rapidly in the near future due to ageing populations and lifestyle factors [3, 4]. Prevention of atrial fibrillation-related strokes is implemented with anticoagulants, and warfarin therapy has been the major option for decades [7]. Direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, edoxaban and apixaban, have come onto the market. DOACs are costly but easier-to-use because of fixed dosing and no need for frequent laboratory monitoring [9]. Anticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. We incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies

Methods

Results

Discussion

Conclusion