Direct vitamin K antagonist anticoagulant treatment health care costs in patients with non-valvular atrial fibrillation.
BACKGROUND
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.


METHODS
This 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.


RESULTS
We 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.


CONCLUSIONS
Most 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.
Álvaro
Á
Hidalgo-Vega
Elham
E
Askari
Rosa
R
Vidal
Department of Economic and Financial Analysis, Faculty of Social Sciences, University of Castilla-La Mancha, Mancha, Avda Real Fábrica de Seda s/n, 45600 Talavera de la Reina Toledo, Spain. Isaac.aranda@uclm.es.
Isaac
I
Aranda-Reneo
Almudena
A
Gonzalez-Dominguez
Alexandra
A
Ivanova
Gabriela
G
Ene
Pilar
P
Llamas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D055815:Young Adult
D000925:Anticoagulants; D014812:Vitamin K