Abstract
BACKGROUND:Atrial fibrillation is the most frequent cardiac arrhythmia; prevalence increases with age and is associated with an increase in the risk of stroke and acute myocardial infarction. Anticoagulants are the treatment of choice to prevent thromboembolic complications and reduce infarction risk in patients with non-valvular atrial fibrillation (NVAF). The utilization of new oral anticoagulants such as dabigatran, rivaroxaban and apixaban has increased, due to the safety profile of vitamin K antagonists.
METHODOLOGY:A budget impact analysis comparing dabigatran, rivaroxaban, apixaban and warfarin in patients with NVAF was carried out from the third payer's perspective. Two scenarios were considered: In the first one, there is a relative decrease on dabigatran utilization compared with apixaban and rivaroxaban. In the other one, dabigatran utilization increased. In both scenarios, warfarin utilization remained constant.
RESULTS:In the scenario in which dabigatran utilization decreased, there was a budget increase of $1,925,441,674 in the second year, and $3,670,041,761 in the third. In the increase of dabigatran utilization scenario, we find a global cost reduction of -$1,498,527,642 in the second year and -$2,119,252,605 in the third.
CONCLUSIONS:Increase of dabigatran utilization throughout the time horizon is a cost saving decision on anticoagulant treatment of NVAF.
References
Xu J, Luc JGY, Phan K. Atrial fibrillation: review of current treatment strategies. J Thorac Dis. 2016;8:E886-900.
Copley DJ, Hill KM. Atrial fibrillation: A review of treatments and current guidelines. AACN Adv Crit Care. 2016;27:120-8.
Rosselli D, Rodríguez AJ, García AA, Rueda JD. Prevalencia de fibrilación auricular en un hospital universitario colombiano. Rev Colomb Cardiol. 2013;20:383-5.
Departamento Administrativo Nacional de Estadística (DANE). Población, Edades Simples, 1985-2020. Proyecciones de Población.
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei ?, et al. 2016. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50:e1-88.
European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GYH, Schotten U, et al. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Europace. 2010;12:1360-420.
Aristizábal J, Uribe W, Medina E, Velásquez JE, Marén JE, Duque M. Atrial fibrillation: a current view. Rev Colomb Cardiol. 2012;19:235-51.
Hart RG. Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857-67.
Mangiafico RA, Mangiafico M. Emerging anticoagulant therapies for atrial fibrillation: new options, new challenges. Curr Med Chem. 2012;19(27):4688-98.
Ganetsky M, Babu KM, Salhanick SD, Brown RS, Boyer EW Dabigatran: Review of pharmacology and management of bleeding complications of this novel oral anticoagulant. J Med Toxicol. 2011;7:281-7.
Martínez-Rubio A, Dan GA, Kaski JC. Rivaroxaban and stroke prevention in patients with atrial fibrillation: new evidence. Expert Rev Cardiovasc Ther. 2014;12:933-47.
Cubillos I, Haddad A, Kuznik A, Mould-Quevedo J. Burden of disease from atrial fibrillation in adults from seven countries in Latin America. Int J Gen Med. 2014;7:441-8.
Mora-Llabata V, Dubois-Marqués D, Roldán-Torres I, Mateu-Navarro C, Sanz-García JJ, Moreno-Ballester V, et al. Prevalencia de fibrilación auricular y características de la fibrilación auricular no valvular en la población general. Registro AFINVA. Rev Colomb Cardiol. 2017;24:26-33.
Triana JJ, Castañeda C, Parada L, Otálora-Esteban M, Rosselli D. Costo-efectividad de dabigatrán comparado con warfarina para el tratamiento de pacientes con fibrilación auricular no valvular. Rev Colomb Cardiol. 2016;23:82-6.
Rosselli D, Castaño N, Arciniegas J, García A, Muñoz O, Gómez-Restrepo C. Costo-efectividad de las estatinas para el tratamiento de dislipidemia en Colombia. Acta Med Colomb. 2015;40:118-24.
Kodani E, Atarashi H, Inoue H, Okumura K, Yamashita T, Origasa H, et al. Secondary prevention of stroke "with warfarin in patients with nonvalvular atrial fibrillation: Subanalysis of the J-RHYTHM registry. J Stroke Cerebrovasc Dis. 2016;25:585-99.
Tawfik A, Bielecki JM, Krahn M, Dorian P, Hoch JS, Boon H, et al. Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation. Clin Pharmacol. 2016;8:93-107.
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