Varfarin veya Yeni Nesil Oral Antikoagülan Kullanan Atriyal Fibrilasyonlu Hastalarda Tedavi Maliyetinin Analiz Çalışması

Year 2021, , 322 - 327, 29.06.2021

Ercan Aydın , Aydın Kant , Altuğ Ösken , Salih Şahinkuş , Selcuk Yaylacı

https://doi.org/10.31832/smj.844292

Abstract

Amaç: Atriyal fibrilasyonu olan hastalarda varfarin ve yeni nesil oral antikoagülan (NOAC) tedavisinin maliyet analizini karşılaştırdık.
Gereç ve Yöntemler: Kardiyoloji polikliniğinden atriyal fibrilasyon tanısı alan, varfarin veya NOAC tedavisi kullanan 494 hasta retrospektif olarak çalışmaya dahil edildi. Poliklinik hizmet ücreti ,antikoagülanların neden olduğu kanama nedeniyle hastaneye yatış ücretleri ve antikoagülan ilaç maliyeti dahil edilerek Sosyal Güvenlik Kurumunca ödenen ücretlerin karşılaştırılması yapıldı.
Bulgular: Çalışma grubunda antikoagülan ilaç kullanıcılarının %18.8'i varfarin, %81.2'si NOACs kullanıyordu. Varfarin kullanan hastalarda poliklinik muayene hizmet sayısı daha yüksekti. Hasta grupları arasında cinsiyet açısından istatistiksel bir fark görülmedi fakat NOAC kullanan hastalarda ortalama yaş daha yüksekti (p<0.026). Varfarin kullanan hastalarda poliklinik muayene hizmet ve hastaneye yatış ücretleri daha yüksek fakat NOAC hastalarında toplam maliyetler daha yüksekti (p<0.001).
Sonuç: NOAC ilaçlarının hemorajik komplikasyonları ve hastaneye yatış sıklığı düşüktür ve poliklinik muayene ücretleri açısından daha avantajlıdr. NOAC ilaçlarının fiyatları daha düşük olsa, toplam maliyet azalacak ve bu ilaçlar varfarin'e göre toplam maliyet açısından daha avantajlı olacaktır

Keywords

Yeni nesil oral antikoagülan, varfarin, maliyet analizi

Treatment Cost Analysis Study In Patients with Atrial Fibrillation Using Warfarin or New Generation Oral Anticoagulant

Abstract

Objective:We compared the cost analysis of warfarin and new-generation oral anticoagulant (NOAC) treatment in patients with atrial fibrillation.

Materials and Methods:Four hundred and ninety-four patients diagnosed with atrial fibrillation at the cardiology outpatient clinic (OC) and using warfarin or NOAC therapy were retrospectively included in the study.Comparison of the total cost of OC and examination fees paid by the social security institution; Fees related to hospitalizations due to hemorrhage caused by anticoagulants and anticoagulant drug cost were compared.

Results: In the study group, 18.8% of the anticoagulant drug users were using warfarin, and 81.2% were using NOACs. The average number of admission to OC is more prevalent in patients using warfarin. No statistical difference was observed in gender between patients, but patients using NOAC had a higher mean age (p<0.026).The costs of OC examination and hospitalization were higher in patients receiving warfarin medication but the total costs were higher in NOAC patients (p<0.001).

Conclusion:Hemorrhagic complications of NOAC drugs and hospitalization frequency are low, and the cost of OC examination is beneficial. If the NOAC prices are lower, the total cost will be reduced and these drugs will be more favorable than warfarin.

Keywords

New-generation oral anticoagulant, warfarin, cost analysis

References

• 1. Pistoia F, Sacco S, Tiseo C, Degan D, Ornello R, Carolei A. The Epidemiology of Atrial Fibrillation and Stroke. Cardiol Clin. 2016;34(2):255-68.
• 2) Uyarel H, Onat A, Yüksel H, Can G, Ordu S, Dursunoğlu D. Incidence, prevalence and mortality estimates for chronic atrial fibrillation in Turkish adults. Arch Turk Soc Cardiol. 2008;36:214–22.
• 3) Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1-e88.
• 4) Cavallari I, Patti G. Efficacy and safety of oral anticoagulation in elderly patients with atrial fibrillation. Anatol J Cardiol. 2018;19(1): 67–71.
• 5) Bobade RA, Helmers RA, Jaeger TM, Odell LJ, Haas DA, Kaplan RS. Time-driven activity-based cost analysis for outpatient anticoagulation therapy: direct costs in a primary care setting with optimal performance. Journal of Medical Economics. 2019;22(5): 471–477.
• 6) Shannon L. Reynolds, 1 Sameer R. Ghate,2 Richard Sheer,1 Pranav K. Gandhi,2 Chad Moretz,1 Cheng Wang,2 Stephen Sander,2 Mary E. Costantino,1 Srinivas Annavarapu,1 George Andrews3 Healthcare utilization and costs for patients initiating Dabigatran or Warfarin .DisclaimerHealth Qual Life Outcomes. 2017; 15: 128.
• 7)Varim P, Varim C, Ergenç H, Uyanık M, Yaylacı S, Vatan M, Gündüz H. ASSESSMENT OF WARFARIN TREATMENT EFFICACY BY MEANS; OF USING COAGULATION TEST RESULTS WITHIN THE THERAPEUTIC RANGE. Georgian Med News. 2016 Jun;(255):62-6. PMID: 27441538.
• 8)Kaya H, Ertaş F, Kaya Z, et al. Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER). Cardiol J 2014; 21: 158-62.
• 9) Nieuwlaat R, Connolly BJ, Hubers LM, et al. ACTIVE Investigators. Quality of individual INR control and the risk of stroke and bleeding events in atrial fibrillation patients: a nested case control analysis of the ACTIVE W study. Thromb Res 2012; 129: 715-719
• 10)Sorensen SV, Dewilde S, Singer DE, Goldhaber SZ, Monz BU, Plumb JM. Cost-effectiveness of warfarin: Trialversus"real-world" stroke prevention in atrial fibrillation. American HeartJournal. 2009;157(6): 1064-73.
• 11) Canestaro WJ, Patrick AR, Avorn J, Ito K, Matlin OS, Brennan TA, et al. Cost-effectiveness of oral anticoagulants for treatment of atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2013;6:724-731.
• 12) Lip G, Keshishian A, Li X, Hamilton M, Masseria C, Gupta K, et al. Effectiveness and safety of oral anticoagulants among nonvalvular atrial fibrillation patients. Stroke. 2018; 49(12):2933-2944.
• 13) Kenechukwu Mezue,1,* Chukwudi Obiagwu,2 Jinu John,3 Abhishek Sharma,4 Felix Yang,3Jacob Shani3. Novel Oral Anticoagulants in Atrial Fibrillation. Update on Apixaban. Curr Cardiol Rev. 2017 Feb; 13(1): 41–46.
• 14) Başarıcı İ, Kılınc AY. New Oral Anticoagulants.Turkiye Klinikleri; 2019. p.90-100.