Vnitr Lek 2022, 68(1):26-33 | DOI: 10.36290/vnl.2022.004

Direct costs in patients with nonvalvular atrial fibrillation newly indicated to apixaban: a retrospective‑prospective single‑arm cohort study

Daniela Štrosová^1,*, Jan Tužil^{1, 2,*}, Barbora Pilnáčková¹, Lada Lžičařová¹, Veronika Typovská³, Helena Doležalová¹, Martin Herold^{4, 5}, Tomáš Doležal^{1, 6}

¹ VALUE OUTCOMES s. r. o., Praha

² 1. lékařská fakulta, Univerzita Karlova, Praha

³ Pfizer, Praha

⁴ Kardiologická klinika, Fakultní nemocnice Královské Vinohrady, Praha

⁵ Kardiologická klinika, 3. lékařská fakulta, Univerzita Karlova, Praha

⁶ Farmakologický ústav, Masarykova univerzita, Brno

^* Tito autoři přispěli stejnou měrou

Background: Atrial fibrillation (AF) affects 46.3 million people; its prevalence has tripled over the last 50 years. AF leads to formation of blood clots increasing four-fold the risk of a stroke. Preventive anticoagulant therapy with warfarin has been well established for over 50 years but has efficacy and safety limitations. New anticoagulants do not require laboratory monitoring of prothrombin time, have low risk of adverse events, yet are more costly.

Methods: This non-interventional (Act 378/2007 Coll.) retrospective-prospective single-arm cohort study consisted of 3 visits. The primary objective was to compare the total direct cost of treatment with warfarin and apixaban. Patients with non-valvular AF were enrolled at the time of discontinuation of warfarin and switching to apixaban. Costs were derived from the care provided and the list of medical procedures (Decrees 268/ 2019 Coll.). Satisfaction was assessed using SAFUCA® questionnaire.

Results: Between February 2017 and June 2019, 499 patients were enrolled in 29 Czech internal medicine clinics. The mean age of the patients was 73.6 ± 10.2 years, 36.5% were at high risk of bleeding (HAS-BLED score). Previous warfarin treatment lasted 5.9 ± 2.7 months, 63% were unable to achieve target prothrombin time, 18% switched due to adverse reactions. New apixaban treatment was followed for the first 6 months. Treatment with warfarin was associated with higher rates of major bleeding and adverse events (22 vs. 2), stroke (17 vs. 0), ischemic heart attack (11 vs. 0), and minor bleeding (173 vs. 2). The average daily cost following the switch to apixaban decreased from CZK 65.2 to CZK 4.8 (p <0.001). The price of anticoagulant treatment was considered, there was an insignificant increase from CZK 68.1 to CZK 71.7 (p = 0.509). Satisfaction increased significantly after 3 months, notably in the subjective evaluation of efficacy, comfort, impact on quality of life and the occurrence of side effects.

Conclusion: Switching patients with unsatisfactory outcomes on warfarin to apixaban resulted in lower risk of serious ischemic events, bleeding and side effects, and higher patient satisfaction. From the pharmacoeconomic perspective, apixaban is a better choice in this population as it brings higher efficacy and better safety within comparable overall direct costs.

Keywords: anticoagulation, atrial fibrillation, direct costs, apixaban, warfarin, bleeding, real world evidence.

Published: February 14, 2022  Show citation