ArticleBMC health services research2019
Modeling patients' time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants.
Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Real-World Patterns and Outcomes of Anticoagulation Therapy in Pulmonary Embolism: An Observational Dual-Centre Registry Analysis.Journal of cardiovascular development and disease · 2025Article
- A Cost-Effectiveness Analysis of Rivaroxaban Compared to Warfarin for the Management of Venous Thromboembolism in Western Kenya.Clinical drug investigation · 2025Article
- Reimbursement and use of oral anticoagulants during 2014-2022 - A register-based study.Exploratory research in clinical and social pharmacy · 2023Article
- Nationwide Implementation of a Population Management Dashboard for Monitoring Direct Oral Anticoagulants: Insights From the Veterans Affairs Health System.Circulation. Cardiovascular quality and outcomes · 2023Article
- Service quality and accessibility of healthcare facilities: digital healthcare potential in Ho Chi Minh City.BMC health services research · 2022Article
- Warfarin Adherence Among Patients with Atrial Fibrillation in Rural Area of Dongyang, China: A Questionnaire-Based Study.Patient preference and adherence · 2022Article
- Economy- and Social-Based Strategies for Anticoagulation of Patients with Atrial Fibrillation.Arquivos brasileiros de cardiologia · 2022Article
- Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin.BMC health services research · 2021Article
- Cost-Effectiveness of Apixaban versus Other Direct Oral Anticoagulants and Warfarin in the Prevention of Thromboembolic Complications Among Finnish Patients with Non-Valvular Atrial Fibrillation.ClinicoEconomics and outcomes research : CEOR · 2021Article
- Are DOACs a Good Bang for Your Buck in Atrial Fibrillation Prevention in Real-Life?Arquivos brasileiros de cardiologiaArticle
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Authors and funding
5 authors.
Funding
Abstract
backgroundAnticoagulation therapy is used for atrial fibrillation (AF) patients for reducing the risk of cardioembolic complications such as stroke. The previously recommended anticoagulant, warfarin, has a narrow therapeutic window, and it requires regular laboratory monitoring, unlike direct oral anticoagulants (DOAC). From a societal perspective, it is important to measure time and travel costs associated with warfarin monitoring to better compare the total therapy costs of these two alternative forms of anticoagulation management. In this study we design a georeferenced cost model to investigate societal savings achievable with the shift from warfarin to DOACs in the study region of North Karelia in Eastern Finland.
methodsIndividual-level patient data of 6519 AF patients was obtained from the regional patient database. Patients' geocoded home addresses and other GIS data were used to perform a network analysis for the optimal routes for warfarin monitoring visits. These measures of revealed accessibility were then used in the cost model to measure monetary time and travel costs in addition to direct healthcare costs of anticoagulation management.
resultsThe share of time and travel costs in warfarin monitoring is 26.6% of the total therapy costs in our study region. With current drug retail prices in Finland, the societal expense of anticoagulation management is only 2.6% higher with DOACs than in the baseline with warfarin. However, when 25% lower distributor's prices are used, the total societal cost decreases by 13.6% with DOACs.
conclusionsOur results indicate that patients' time and travel costs critically increase the societal cost of warfarin therapy; and despite the higher price of DOACs, they are already cost-efficient alternatives to warfarin in anticoagulation management. In the future, the cost of AF complications should be included in the cost comparison between warfarin and DOACs. Our modeling approach applies to different geographical regions and to different healthcare processes requiring patient monitoring.
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