An economic model of adverse events and costs for oral anticoagulants used for atrial fibrillation

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To construct a semi-Markov model to compare health outcomes and medical costs associated with warfarin and a second anticoagulant over 1- and 5-year periods. Design: We posited a hypothetical cohort of 10000 identical 70-year-old patients with atrial fibrillation. We posited 20 scenarios for events that included four possibilities for ischemic strokes (mild, moderate, severe, death) and 16 possibilities for hemorrhages. The model allowed for four levels of International Normalized Ratio. Event rates were based on outcomes in clinical trials and observational studies. Costs were estimated from the perspective of the third-party payer. Results: The greatest cost-generating events were virtually the same for the two drugs and included severe stroke ($1 758 548 for 1 year for both drugs), moderate stroke ($380 355 for 1 year for both drugs), and severe lower gastrointestinal (GI) hemorrhage ($193 804 for 1 year for warfarin and $193 474 for second drug). The least costly events for both drugs were mild intracranial or intracerebral hemorrhage ($7584 for warfarin and $4314 for second drug) and fatal upper GI hemorrhage ($16 781 and $16 752). Total costs for adverse events over 5 years were similar: $18 330 662 for warfarin and $17 102 847 for the second drug. Fatalities for 5 years were 123 for warfarin and 101 for the non-warfarin drug. Varying assumptions for nursing home care and numbers of ischemic strokes and hemorrhages generated the widest variation in costs. Limitations: We did not account for out-of-pocket expenses, 'pain and suffering' costs, or variation across practice settings. Conclusions: There was substantial variation in numbers and costs of adverse events across 20 scenarios, and for fatalities between the two drugs, but variation in costs between the two drugs was modest.

Original languageEnglish (US)
Pages (from-to)2071-2081
Number of pages11
JournalCurrent Medical Research and Opinion
Volume23
Issue number9
DOIs
StatePublished - Sep 2007

Fingerprint

Economic Models
Anticoagulants
Atrial Fibrillation
Costs and Cost Analysis
Warfarin
Pharmaceutical Preparations
Stroke
Gastrointestinal Hemorrhage
Hemorrhage
Health Insurance Reimbursement
International Normalized Ratio
Intracranial Hemorrhages
Cerebral Hemorrhage
Home Care Services
Nursing Care
Health Expenditures
Nursing Homes
Psychological Stress
Observational Studies
Clinical Trials

Keywords

  • Anticoagulants
  • Cost-effectiveness
  • Economics
  • Warfarin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{719de9143a814c3d84a4990140960583,
title = "An economic model of adverse events and costs for oral anticoagulants used for atrial fibrillation",
abstract = "Objective: To construct a semi-Markov model to compare health outcomes and medical costs associated with warfarin and a second anticoagulant over 1- and 5-year periods. Design: We posited a hypothetical cohort of 10000 identical 70-year-old patients with atrial fibrillation. We posited 20 scenarios for events that included four possibilities for ischemic strokes (mild, moderate, severe, death) and 16 possibilities for hemorrhages. The model allowed for four levels of International Normalized Ratio. Event rates were based on outcomes in clinical trials and observational studies. Costs were estimated from the perspective of the third-party payer. Results: The greatest cost-generating events were virtually the same for the two drugs and included severe stroke ($1 758 548 for 1 year for both drugs), moderate stroke ($380 355 for 1 year for both drugs), and severe lower gastrointestinal (GI) hemorrhage ($193 804 for 1 year for warfarin and $193 474 for second drug). The least costly events for both drugs were mild intracranial or intracerebral hemorrhage ($7584 for warfarin and $4314 for second drug) and fatal upper GI hemorrhage ($16 781 and $16 752). Total costs for adverse events over 5 years were similar: $18 330 662 for warfarin and $17 102 847 for the second drug. Fatalities for 5 years were 123 for warfarin and 101 for the non-warfarin drug. Varying assumptions for nursing home care and numbers of ischemic strokes and hemorrhages generated the widest variation in costs. Limitations: We did not account for out-of-pocket expenses, 'pain and suffering' costs, or variation across practice settings. Conclusions: There was substantial variation in numbers and costs of adverse events across 20 scenarios, and for fatalities between the two drugs, but variation in costs between the two drugs was modest.",
keywords = "Anticoagulants, Cost-effectiveness, Economics, Warfarin",
author = "Leigh, {J Paul} and White, {Richard H}",
year = "2007",
month = "9",
doi = "10.1185/030079907X210822",
language = "English (US)",
volume = "23",
pages = "2071--2081",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Informa Healthcare",
number = "9",

}

TY - JOUR

T1 - An economic model of adverse events and costs for oral anticoagulants used for atrial fibrillation

AU - Leigh, J Paul

AU - White, Richard H

PY - 2007/9

Y1 - 2007/9

N2 - Objective: To construct a semi-Markov model to compare health outcomes and medical costs associated with warfarin and a second anticoagulant over 1- and 5-year periods. Design: We posited a hypothetical cohort of 10000 identical 70-year-old patients with atrial fibrillation. We posited 20 scenarios for events that included four possibilities for ischemic strokes (mild, moderate, severe, death) and 16 possibilities for hemorrhages. The model allowed for four levels of International Normalized Ratio. Event rates were based on outcomes in clinical trials and observational studies. Costs were estimated from the perspective of the third-party payer. Results: The greatest cost-generating events were virtually the same for the two drugs and included severe stroke ($1 758 548 for 1 year for both drugs), moderate stroke ($380 355 for 1 year for both drugs), and severe lower gastrointestinal (GI) hemorrhage ($193 804 for 1 year for warfarin and $193 474 for second drug). The least costly events for both drugs were mild intracranial or intracerebral hemorrhage ($7584 for warfarin and $4314 for second drug) and fatal upper GI hemorrhage ($16 781 and $16 752). Total costs for adverse events over 5 years were similar: $18 330 662 for warfarin and $17 102 847 for the second drug. Fatalities for 5 years were 123 for warfarin and 101 for the non-warfarin drug. Varying assumptions for nursing home care and numbers of ischemic strokes and hemorrhages generated the widest variation in costs. Limitations: We did not account for out-of-pocket expenses, 'pain and suffering' costs, or variation across practice settings. Conclusions: There was substantial variation in numbers and costs of adverse events across 20 scenarios, and for fatalities between the two drugs, but variation in costs between the two drugs was modest.

AB - Objective: To construct a semi-Markov model to compare health outcomes and medical costs associated with warfarin and a second anticoagulant over 1- and 5-year periods. Design: We posited a hypothetical cohort of 10000 identical 70-year-old patients with atrial fibrillation. We posited 20 scenarios for events that included four possibilities for ischemic strokes (mild, moderate, severe, death) and 16 possibilities for hemorrhages. The model allowed for four levels of International Normalized Ratio. Event rates were based on outcomes in clinical trials and observational studies. Costs were estimated from the perspective of the third-party payer. Results: The greatest cost-generating events were virtually the same for the two drugs and included severe stroke ($1 758 548 for 1 year for both drugs), moderate stroke ($380 355 for 1 year for both drugs), and severe lower gastrointestinal (GI) hemorrhage ($193 804 for 1 year for warfarin and $193 474 for second drug). The least costly events for both drugs were mild intracranial or intracerebral hemorrhage ($7584 for warfarin and $4314 for second drug) and fatal upper GI hemorrhage ($16 781 and $16 752). Total costs for adverse events over 5 years were similar: $18 330 662 for warfarin and $17 102 847 for the second drug. Fatalities for 5 years were 123 for warfarin and 101 for the non-warfarin drug. Varying assumptions for nursing home care and numbers of ischemic strokes and hemorrhages generated the widest variation in costs. Limitations: We did not account for out-of-pocket expenses, 'pain and suffering' costs, or variation across practice settings. Conclusions: There was substantial variation in numbers and costs of adverse events across 20 scenarios, and for fatalities between the two drugs, but variation in costs between the two drugs was modest.

KW - Anticoagulants

KW - Cost-effectiveness

KW - Economics

KW - Warfarin

UR - http://www.scopus.com/inward/record.url?scp=36049037618&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36049037618&partnerID=8YFLogxK

U2 - 10.1185/030079907X210822

DO - 10.1185/030079907X210822

M3 - Article

C2 - 17651537

AN - SCOPUS:36049037618

VL - 23

SP - 2071

EP - 2081

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 9

ER -