title: Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis.
abstract: OBJECTIVE
  Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system.
  
  
  METHODS
  Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil.
  
  
  METHODS
  Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015.
  
  
  RESULTS
  This study included 633 patients (59% women) of median age 62 years (interquartile range -49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $ 54.26 (US dollars). Direct costs accounted for 32.5% of the total cost. Of these, 69.5% were related to healthcare professionals. With regards to indirect costs, 52.4% were related to absence from work and 47.6% to transportation. Apixaban, dabigatran and rivaroxaban were being sold to Brazilian public institutions, on average, for $ 49.87, $ 51.40 and $ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment.
  
  
  CONCLUSIONS
  In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.
authors: MD, MSc, PhD. Adjunct Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
authors: Milena Soriano
authors: MS
authors: Marcolino
authors: MD, MSc, PhD. Adjunct Professor, Department of Internal Medicine, Medical School, Universidade Federal Rio Grande do Sul (UFRGS), Porto Alegre, RS; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
authors: Carisi Anne
authors: CA
authors: Polanczyk
authors: MD. Cardiology Resident, Instituto Dante Pazzanese de Cardiologia (IDPC), São Paulo, SP, Brazil.
authors: Ana Carolina Caixeta
authors: AC
authors: Bovendorp
authors: MD. Attending Physician, Family Health Program, Belo Horizonte, MG, Brazil.
authors: Naiara Silveira
authors: NS
authors: Marques
authors: Manager, Dispensing Pharmacy, Hospital Júlia Kubitschek (HJK), Belo Horizonte, MG, Brazil.
authors: Lilian Azevedo da
authors: LA
authors: Silva
authors: Nurse, Unimed-BH, Belo Horizonte, MG, Brazil.
authors: Cintia Proveti Barbosa
authors: CP
authors: Turquia
authors: MD, MSc, PhD. Full Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
authors: Antonio Luiz
authors: AL
authors: Ribeiro
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000191:economics / Q000517:prevention & control; D001938:Brazil; D003365:Costs and Cost Analysis; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D012016:Reference Values; D015203:Reproducibility of Results; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran