Budget impact analysis of warfarin reversal therapies among hip fracture patients in Finland.
BACKGROUND
Hip fractures require operation within 36-48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches.


METHODS
Four reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC).


RESULTS
We estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland. The least costly treatment was vitamin K, which accounted for €289,000 in direct healthcare costs, and the most costly treatment option was warfarin cessation, which accounted for €1,157,000. In the budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with the current treatment mix.


CONCLUSIONS
The various warfarin reversal strategies have different onset times, which may substantially impact the subsequent healthcare costs.
Oy Medfiles Ltd, Volttikatu 5, P.O. Box 1450, 70701, Kuopio, Finland, timo.purmonen@medfiles.eu.
Timo
T
Purmonen
Soili
S
Törmälehto
Niina
N
Säävuori
Hannu
H
Kokki
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000191:economics; D002017:Budgets; D005260:Female; D005387:Finland; D017048:Health Care Costs; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010949:Plasma; D013997:Time Factors; D014812:Vitamin K / Q000008:administration & dosage / Q000191:economics; D014859:Warfarin / Q000009:adverse effects / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin