title: The Cost Differential Between Warfarin Versus Aspirin Treatment After a Fontan Procedure.
abstract: BACKGROUND
  The use of aspirin versus warfarin for treatment of patients after a Fontan procedure remains contentious. Current preference-based models of treatment across Australia and New Zealand show variation in care that is unlikely to reflect patient differences and/or clinical risk.
  
  
  METHODS
  We combine data from the Australian and New Zealand Fontan Registry and a home INR (International Normalised Ratio) monitoring program (HINRMP) from the Royal Children's Hospital (RCH) Melbourne, to estimate the cost difference for Fontan recipients receiving aspirin versus warfarin for 2015. We adopt a societal perspective to costing which includes cost to the health system (e.g. medical consults, pathology tests) and costs to patients and carers (e.g. travel and time), but excludes costs of adverse events. Costs are presented in Australian 2015 dollars; any costs from previous years have been inflated using appropriate rates from the Australian Bureau of Statistics.
  
  
  RESULTS
  We find that warfarin patients face additional costs of $825 per annum, with the majority ($584 or 71%) of those borne by the patient or family. If aspirin is as clinically as effective as warfarin, Fontan recipients could be enjoying far less costly, invasive and time-consuming treatment. While achieving such clinical consensus can be difficult, economics shows us that there are large costs associated with a failure to achieve it.
authors.affiliation: Centre for Health Policy, the University of Melbourne, Melbourne, Vic, Australia. Electronic address: chris.schilling@unimelb.edu.au.
authors.forename: Chris
authors.initials: C
authors.lastname: Schilling
authors.affiliation: Centre for Health Policy, the University of Melbourne, Melbourne, Vic, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Dalziel
authors.affiliation: Cardiac Surgery Department, Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, Faculty of Medicine, the University of Melbourne, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Iyengar
authors.affiliation: Cardiac Surgery Department, Royal Children's Hospital, Melbourne, Vic, Australia; Department of Paediatrics, Faculty of Medicine, the University of Melbourne, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000191:economics*; D001315:Australia; D003365:Costs and Cost Analysis; D005260:Female; D018729:Fontan Procedure / Q000191:economics*; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics*; D008297:Male; D009520:New Zealand; D012042:Registries; D014859:Warfarin / Q000008:administration & dosage / Q000191:economics*
chemical_list: D014859:Warfarin; D001241:Aspirin
keywords: Congenital heart disease; Costs; Fontan; Warfarin