CP-041 New oral anticoagulants in non-valvular atrial fibrillation patients who are candidates for elective cardioversion: an example of budget impact analysis

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Abstract

Background

Information relating to the efficacy and safety of new oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation who are candidates for electrical or pharmacological cardioversion is still limited in the literature. However, guidelines enable the clinician to choose between vitamin K antagonists (VKA) and NOACs.

Purpose

Our aim was to understand the characteristics of the setting of the two treatments and the possible consequences on the budget of the use of available therapies. A budget impact analysis (BIA) was conducted.

Material and methods

A BIA was performed from the perspective of the SSR and the hospital, and also involved sensitivity analysis involving possible scenarios in normal clinical practice.

Results

The expenditure paid out by SSR was greater in the case of patients receiving cardioversion therapy NOAC (€684.40) than those receiving VKA (€620.79). Although the cost regarding the performance of the TAO Centre (start of therapy and subsequent monitoring) was higher (€115.40 first and € 93.60 after the procedure), the cost of drug therapy was less (€7.99 warfarin compared with €243.09 per NOAC net of distribution costs) and therefore for the SSR it is more convenient to treat patient with VKA in the presence of optimal INR control. The threshold value of the cost of NOAC was calculated or what cost/day would cancel the difference with VKA, estimated at €1.68/day, equivalent to a reduction of about 23% over list price/day (€2.19). Statements obtained showed that the costs that the centre incurs are considerably higher (€652.98) than the SSR repayments with the amounts of the DRG (€198). Sensitivity analysis confirmed the findings from analysis of the baseline scenario.

Conclusion

Cardioversion presents non-negligible risks with a significant economic impact on the SSR and the hospital—in particular, anticoagulant therapy is not appropriate. The BIA has enabled us to estimate that, to date, treatment with VKA is the most convenient for the SSR. The hospital pharmacist needs to assess the prescriptive appropriateness of anticoagulant therapy in accordance with indications and to undertake a proactive role in the analysis of the profile and security management, effectiveness and sustainability.

Conclusion

No conflict of interest

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