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05.01.2019 | Original Article | Ausgabe 6/2019

Heart and Vessels 6/2019

Cost-effectiveness for prevention of thromboembolism by anticoagulants in non-valvular atrial fibrillation: additional analysis from the Hokuriku˗Plus AF Registry

Zeitschrift:
Heart and Vessels > Ausgabe 6/2019
Autoren:
Masakazu Yamagishi, Toyonobu Tsuda, Takeshi Kato, Hiroshi Furusho, Kenshi Hayashi, The Hokuriku˗plus AF Registry Research Group
Wichtige Hinweise
This study was presented at the 82nd Annual Scientific Meeting of the Japanese Circulation Society in 2018, Osaka.
The members of the Hokuriku˗plus AF Registry research group are listed in the “Acknowledgements”.

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Abstract

Although benefits of direct oral anticoagulants (DOAC) for treatment of non-valvular atrial fibrillation (AF) were well demonstrated, few data exist regarding cost-effectiveness between DOAC and warfarin uses in real-world clinical practice. Therefore, we estimated total cost of treatment for AF by authorized cardiologists in Japan. We studied consecutive 617 anticoagulated non-valvular AF patients (418 men, mean age 68.8, 54% warfarin) consulted by authorized cardiologists. The mean time in therapeutic range of warfarin was 71.8%. Under these conditions, we calculated the cost of anticoagulants, laboratory examination, and hospitalization due to thromboembolism or bleeding during follow-up for 3.1 years. Thromboembolism occurred in 26 patients (4.2%, 1.3/100 person-year) and hemorrhagic events in 20 patients (3.2%, 1.0/100 person-year). There was no significant difference in the occurrence rate of thromboembolism (log rank P = 0.16) or hemorrhagic events (log rank P = 0.83) between these two groups. Importantly, warfarin group showed lower cost than DOAC group (117,361 ± 743,710 yen/year vs. 310,436 ± 1,075,639 yen/person, P = 0.009) in terms of cost including drug, medical check, and hospitalization. These results demonstrate that the total cost with warfarin can be lower than DOAC in treatment for AF by authorized cardiologists in Japan, although further prospective randomized cost calculation is necessary including post-discharge care fee.

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