Evidence map›Paper›PMID 35665481›Full record

ArticlePharmacoEconomics - open2022

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

Sabine Michelsen Raunbak, Anne Sig Sørensen, Louise Hansen, Flemming Skjøth, Torben Bjerregaard Larsen, Lars Holger Ehlers

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PharmacoEconomics - open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
0.5field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Sabine Michelsen RaunbakDanish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark. smr@dcm.aau.dk.ORCID http://orcid.org/0000-0003-2859-7825
Anne Sig SørensenDanish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.ORCID https://orcid.org/0000-0001-9769-1490
Louise HansenDanish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.ORCID http://orcid.org/0000-0002-4400-2732
Flemming SkjøthAalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.ORCID http://orcid.org/0000-0003-2975-647X
Torben Bjerregaard LarsenAalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.ORCID https://orcid.org/0000-0002-8485-8674
Lars Holger EhlersDanish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.ORCID http://orcid.org/0000-0001-6512-5566
Aalborg University · DKAalborg University Hospital · DKNorth Denmark Region · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatient 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.

methodsA 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.

resultsThe 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.

conclusionsThe 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.

Identifiers

PMID35665481
PMCPMC9283633
OpenAlexW4281680143

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.