The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention


Norliana Masbah*, Mary Joan Macleod

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fbrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. Aim: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Methods: Hospitaliza-tion records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Results: Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospital-izations. Only 254 patients (39.4%) with con-frmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically in-significant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. Conclusion: AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.

Original languageEnglish
Pages (from-to)220-230
Number of pages11
JournalInternational Journal of Clinical Pharmacology and Therapeutics
Volume55
Issue number3
DOIs
Publication statusPublished - Mar 2017

Fingerprint

Cost Savings
Anticoagulants
Atrial Fibrillation
Stroke
Costs and Cost Analysis
Warfarin
Inpatients
Drug Costs
National Health Programs
Scotland
Length of Stay
Hospitalization
Clinical Trials

Keywords

  • Atrial fbrillation
  • Cost saving
  • Novel oral anticoagulants
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology
  • Pharmacology (medical)

Cite this

@article{287a910d87834fc6997b05fa6453aab5,
title = "The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention
",
abstract = "Background: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fbrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. Aim: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Methods: Hospitaliza-tion records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Results: Out of the total stroke cases, 29.5{\%} of total stroke cases were secondary to AF, and these cases were more severe with longer hospital-izations. Only 254 patients (39.4{\%}) with con-frmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically in-significant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1{\%} in total cost reduction. Conclusion: AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.",
keywords = "Atrial fbrillation, Cost saving, Novel oral anticoagulants, Stroke",
author = "Norliana Masbah and Macleod, {Mary Joan}",
note = "Not required for REF.",
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journal = "International Journal of Clinical Pharmacology and Therapeutics",
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T1 - The cost savings of newer oral anticoagulants in atrial fibrillation-related stroke prevention


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AU - Macleod, Mary Joan

N1 - Not required for REF.

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N2 - Background: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fbrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. Aim: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Methods: Hospitaliza-tion records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Results: Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospital-izations. Only 254 patients (39.4%) with con-frmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically in-significant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. Conclusion: AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.

AB - Background: Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fbrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. Aim: This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Methods: Hospitaliza-tion records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Results: Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospital-izations. Only 254 patients (39.4%) with con-frmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically in-significant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. Conclusion: AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin.

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