IDEAS home Printed from https://ideas.repec.org/a/spr/pharmo/v6y2022i4d10.1007_s41669-022-00337-3.html
   My bibliography  Save this article

Cost Effectiveness of Patient Self-Managed Warfarin Compared with Direct Oral Anticoagulants in Atrial Fibrillation: An Economic Evaluation in a Danish Healthcare Sector Setting

Author

Listed:
  • Sabine Michelsen Raunbak

    (Aalborg University)

  • Anne Sig Sørensen

    (Aalborg University
    Danish Health Technology Council)

  • Louise Hansen

    (Aalborg University
    North Denmark Region)

  • Flemming Skjøth

    (Aalborg University
    Aalborg University Hospital)

  • Torben Bjerregaard Larsen

    (Aalborg University
    Aalborg University Hospital)

  • Lars Holger Ehlers

    (Aalborg University)

Abstract

Background Patient self-managed anticoagulant treatment with warfarin (PSM) has been proposed as an alternative to direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF); however, direct evidence on the cost effectiveness of PSM compared with DOACs is lacking. We aimed to evaluate the cost effectiveness of PSM versus DOACs for NVAF patients in the Danish healthcare setting using a model-based cost-utility analysis. Methods A cost-utility analysis was performed using a decision-analytic model including two treatment alternatives: continuous PSM and DOACs. The analysis was performed from an extended Danish healthcare sector perspective, including patient-paid costs of medication related to the anticoagulant treatment, with a lifetime horizon. Inputs for the model comprised of probabilities of events, costs in Danish estimates, when possible, and effect in utilities. The probabilities of events are primarily based on real-life data from a direct comparison of PSM and DOACs. The results are presented as the incremental cost-effectiveness ratio (ICER) with an assumed cost-effectiveness threshold of £20,000/quality-adjusted life-year (QALY). Both deterministic and probabilistic sensitivity analyses were performed to investigate the robustness of the results. Results The base-analysis showed that PSM was dominant, with a decreased cost of £8495 and an increased QALY accumulation of 0.23 per patient (ICER = −£36,935/QALY). All deterministic sensitivity analyses indicated that PSM was dominant or at least cost effective. The probabilistic sensitivity analysis showed that 95% of the iterations were cost effective. Conclusions The present study found that PSM is dominant (i.e., both more effective and cost saving) compared with DOACs, adding to the scarce evidence of the comparative cost effectiveness of PSM and DOACs in NVAF.

Suggested Citation

  • Sabine Michelsen Raunbak & Anne Sig Sørensen & Louise Hansen & Flemming Skjøth & Torben Bjerregaard Larsen & Lars Holger Ehlers, 2022. "Cost Effectiveness of Patient Self-Managed Warfarin Compared with Direct Oral Anticoagulants in Atrial Fibrillation: An Economic Evaluation in a Danish Healthcare Sector Setting," PharmacoEconomics - Open, Springer, vol. 6(4), pages 483-494, July.
    • Handle: RePEc:spr:pharmo:v:6:y:2022:i:4:d:10.1007_s41669-022-00337-3
    DOI: 10.1007/s41669-022-00337-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s41669-022-00337-3
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1007/s41669-022-00337-3?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Michael Nagler & Lucas M Bachmann & Pirmin Schmid & Pascale Raddatz Müller & Walter A Wuillemin, 2014. "Patient Self-Management of Oral Anticoagulation with Vitamin K Antagonists in Everyday Practice: Efficacy and Safety in a Nationwide Long-Term Prospective Cohort Study," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.

      More about this item

      Statistics

      Access and download statistics

      Corrections

      All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharmo:v:6:y:2022:i:4:d:10.1007_s41669-022-00337-3. See general information about how to correct material in RePEc.

      If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

      If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

      If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

      For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

      Please note that corrections may take a couple of weeks to filter through the various RePEc services.

      IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.