title: Hospital budget implications of substituting dabigatran for warfarin in an anticoagulation service.
abstract: The aim of our study was to assess hospital budget implications of substituting dabigatran for warfarin in patients enrolled in a large anticoagulation service. The study population was identified using criteria from randomized controlled trials of dabigatran. We obtained labor costs ($483 per patient) from the hospital's anticoagulation service budget, laboratory costs of international normalized ratio (INR) tests ($267 per patient), and wholesale costs of warfarin 5 mg tablets ($31 per patient) and dabigatran 150 mg capsules ($2464 per patient). A total of 1774 (93.5%) of 1898 patients were eligible to substitute dabigatran for warfarin. The annual projected hospital expense for anticoagulation with dabigatran was $4,371,136, attributable to drug cost alone. The annual projected cost of warfarin management was $1,385,494. This was comprised of $856,842 for labor, $473,658 for INR testing, and $54,994 for the drug cost of warfarin. Substitution will result in increased expense due to drug cost.
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Atay
authors.forename: Karen
authors.initials: K
authors.lastname: Fiumara
authors.forename: Gregory
authors.initials: G
authors.lastname: Piazza
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D001900:Boston; D002017:Budgets; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D016527:Drug Costs; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics; D007755:Laboratories, Hospital / Q000191:economics; D010564:Personnel, Hospital / Q000191:economics; D019057:Quality-Adjusted Life Years; D012456:Salaries and Fringe Benefits; D020521:Stroke / Q000517:prevention & control; D019851:Thrombophilia / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000191:economics; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran