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Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study

Author

Listed:
  • Siti Norain Azahar

    (Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia)

  • Saperi Sulong

    (Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia)

  • Wan Asyraf Wan Zaidi

    (Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia)

  • Norliza Muhammad

    (Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia)

  • Yusof Kamisah

    (Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia)

  • Norliana Masbah

    (Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia)

Abstract

Background: Stroke has significant direct medical costs, and direct oral anticoagulants (DOACs) are better alternatives to warfarin for stroke prevention in atrial fibrillation (AF). This study aimed to determine the direct medical costs of stroke, with emphasis on AF stroke and the cost-effectiveness of DOACs among stroke patients in a tertiary hospital in Malaysia. Methods: This study utilised in-patient data from the case mix unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 2011 and 2018. Direct medical costs of stroke were determined using a top-down costing approach and factors associated with costs were identified. Incremental cost effectiveness ratio (ICER) was calculated to compare the cost-effectiveness between DOACs and warfarin. Results: The direct medical cost of stroke was MYR 11,669,414.83 (n = 3689). AF-related stroke cases had higher median cost of MYR 2839.73 (IQR 2269.79–3101.52). Regression analysis showed that stroke type (AF versus non-AF stroke) ( p = 0.013), stroke severity ( p = 0.010) and discharge status ( p < 0.001) significantly influenced stroke costs. DOACs were cost-effective compared to warfarin with an ICER of MYR 19.25. Conclusions: The direct medical cost of stroke is substantial, with AF-stroke having a higher median cost per stroke care. DOACs were cost effective in the treatment of AF-related stroke in UKMMC.

Suggested Citation

  • Siti Norain Azahar & Saperi Sulong & Wan Asyraf Wan Zaidi & Norliza Muhammad & Yusof Kamisah & Norliana Masbah, 2022. "Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(3), pages 1-17, January.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1078-:d:728091
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    References listed on IDEAS

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    1. Andrej Janzic & Mitja Kos, 2015. "Cost Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Depending on the Quality of Warfarin Anticoagulation Control," PharmacoEconomics, Springer, vol. 33(4), pages 395-408, April.
    2. Thananan Rattanachotphanit & Chulaporn Limwattananon & Onanong Waleekhachonloet & Phumtham Limwattananon & Kittisak Sawanyawisuth, 2019. "Cost-Effectiveness Analysis of Direct-Acting Oral Anticoagulants for Stroke Prevention in Thai Patients with Non-Valvular Atrial Fibrillation and a High Risk of Bleeding," PharmacoEconomics, Springer, vol. 37(2), pages 279-289, February.
    3. Xue Li & Vicki C Tse & Wallis C Y Lau & Bernard M Y Cheung & Gregory Y H Lip & Ian C K Wong & Esther W Chan, 2016. "Cost-Effectiveness of Apixaban versus Warfarin in Chinese Patients with Non-Valvular Atrial Fibrillation: A Real-Life and Modelling Analyses," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    4. Ali Ali & Joanne Howe & Ahmed Abdel-Hafiz, 2015. "Cost of Acute Stroke Care for Patients with Atrial Fibrillation Compared with Those in Sinus Rhythm," PharmacoEconomics, Springer, vol. 33(5), pages 511-520, May.
    5. Gregoire Mercier & Gerald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.
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