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Cost-effectiveness for prevention of thromboembolism by anticoagulants in non-valvular atrial fibrillation: additional analysis from the Hokuriku˗Plus AF Registry

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Abstract

Although benefits of direct oral anticoagulants (DOAC) for treatment of non-valvular atrial fibrillation (AF) were well demonstrated, few data exist regarding cost-effectiveness between DOAC and warfarin uses in real-world clinical practice. Therefore, we estimated total cost of treatment for AF by authorized cardiologists in Japan. We studied consecutive 617 anticoagulated non-valvular AF patients (418 men, mean age 68.8, 54% warfarin) consulted by authorized cardiologists. The mean time in therapeutic range of warfarin was 71.8%. Under these conditions, we calculated the cost of anticoagulants, laboratory examination, and hospitalization due to thromboembolism or bleeding during follow-up for 3.1 years. Thromboembolism occurred in 26 patients (4.2%, 1.3/100 person-year) and hemorrhagic events in 20 patients (3.2%, 1.0/100 person-year). There was no significant difference in the occurrence rate of thromboembolism (log rank P = 0.16) or hemorrhagic events (log rank P = 0.83) between these two groups. Importantly, warfarin group showed lower cost than DOAC group (117,361 ± 743,710 yen/year vs. 310,436 ± 1,075,639 yen/person, P = 0.009) in terms of cost including drug, medical check, and hospitalization. These results demonstrate that the total cost with warfarin can be lower than DOAC in treatment for AF by authorized cardiologists in Japan, although further prospective randomized cost calculation is necessary including post-discharge care fee.

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Abbreviations

AF:

Atrial fibrillation

BNP:

Brain natriuretic peptide

DOAC:

Direct oral anticoagulant

JCS:

Japanese circulation society

TTR:

Time in therapeutic range

PT-INR:

Prothrombin time–international normalized ratio

TIA:

Transient ischemic attack

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Acknowledgements

The following is a list of the institutions participating in the Hokuriku-plus AF registry: Kanazawa University Hospital (Yamagishi M, Fujino N, Nohara A, Kawashiri MA, Hayashi K, Sakata K, Yoshimuta T, Konno T, Tada H, Hodatsu A, Tsuda T, Nagata Y, Nomura A), Ishikawa Prefectural Central Hospital (Matsubara T, Inoue M, Yasuda T, Miwa K, Yakuta Y, Aburao T, Higashi K, Koga T), Kanazawa Cardiovascular Hospital (Namura M, Horita Y, Ikeda M, Terai H, Kimura R, Tama N, Gamou T, Tsujimoto D, Nakahashi T), Komatsu Municipal Hospital (Ueda Y, Ino H, Higashikata T, Kaneda T, Takata M, Yamamoto R, Yoshikawa T, Ohira M, Suematsu T), Kaga Medical Center (Tagawa S, Okada H, Inoue T), Wajima Municipal Hospital (Kita Y), Suzu General Hospital (Koizumi J, Fujita C, Ukawa N, Inoguchi Y, Matsui T), KKR Hokuriku Hospital (Itoh Y), Saiseikai Kanazawa Hospital (Araki T, Oe K), JCHO Kanazawa Hospital (Minamoto M, Yokawa J, Tanaka Y), Houju Memorial Hospital (Mori K), Toyama Red Cross Hospital (Kaku B, Taguchi T, Katsuda S), Takaoka City Hospital (Haraki T, Hirase H, Fujioka K, Higashi M, Ichise T, Maekawa N, Terada K), Kouseiren Takaoka Hospital (Okeie K, Kiyama M, Fujita T, Oota M), Hokuriku Central Hospital (Todo Y), Fukui Prefectural Hospital (Aoyama T, Yamaguchi M, Noji Y, Mabuchi T, Niwa S, Yagi M, Murai K, Takashima Y, Nishikawa T), Fukui Cardiovascular Center (Mizuno S, Ohsato K, Misawa K, Kokado H), Yokohama Sakae Kyosai Hospital (Michishita I, Iwaki T, Nozue T, Kato H, Nakashima K, Ito S), Ishikawa Health Service Association Clinic (Yamagishi M).

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Authors and Affiliations

  1. Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Masakazu Yamagishi, Toyonobu Tsuda & Kenshi Hayashi

  2. Department of Human Sciences, Osaka University of Human Sciences, Settsu, Japan

    Masakazu Yamagishi

  3. Department of System Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

    Takeshi Kato & Hiroshi Furusho

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  1. Masakazu Yamagishi
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  2. Toyonobu Tsuda
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  3. Takeshi Kato
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  4. Hiroshi Furusho
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  5. Kenshi Hayashi
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The Hokuriku˗plus AF Registry Research Group

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Correspondence to Kenshi Hayashi.

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Conflict of interest

The authors received honoraria for lectures from Daiichi-Sankyo Co. Ltd., Boehringer Ingelheim Japan Co. Ltd., and received scholarship fund from Boehringer Ingelheim Japan Co. Ltd., Bayer Co. Ltd.

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The members of the Hokuriku˗plus AF Registry research group are listed in the “Acknowledgements”.

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Yamagishi, M., Tsuda, T., Kato, T. et al. Cost-effectiveness for prevention of thromboembolism by anticoagulants in non-valvular atrial fibrillation: additional analysis from the Hokuriku˗Plus AF Registry. Heart Vessels 34, 1024–1030 (2019). https://doi.org/10.1007/s00380-018-01333-6

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