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5PSQ-014 Novel oral anticoagulants vs vitamin K antagonists: a cost analysis
  1. M Tonelli,
  2. DA Barila’,
  3. E Caiazza,
  4. M Scaldaferri,
  5. F Cattel
  1. A.O.U. Città Della Salute e Della Scienza di Torino, Hospital Pharmacy, Turin, Italy


Background In elderly patients, anticoagulants are the most commonly implicated medication in emergency department (ED) visits due to an adverse drug event (ADE): 17.6% of all ADE requiring the ED are linked to oral anticoagulant: 50% of them require hospital admission.

Purpose The aim of the study was to assess whether the main reason for hospitalisation is related to ADE of NOACs: to evaluate the potential exposure to drug-drug interactions/assess whether contraindicated drugs have been prescribed in association with NOACs; and evaluate the economic impact associated with NOACs therapy.

Material and methods Data from 2016–2017 were retrieved from administrative and health databases: the File C2 registry which groups all patients admitted to the ED filtered using identified ICD-9-CM codes (International Classification of Diseases) related to ADE possibly induced by anticoagulants; the File F registry, from local health units to identify anticoagulant therapy; and the hospital discharge form (SDO) which stores clinical information about patients. File C2, File F and SDO were matched to estimate costs incurred by the healthcare system: Diagnosis Related Group (DRG) codes were analysed to evaluate the cost/patient.

Results Data of 1867 patients were extrapolated from File C2, matched with File F, through ICD9-CM related to ADE from anticoagulants: 43 patients were selected (median age=80 (σ=12), male:76%). The most frequent diagnoses were: subdural haemorrhage (31%), iron deficiency anaemia and chronic blood loss (22%), subarachnoid haemorrhage (9%) due to Warfarin (75.5%), Dabigatran (8.9%), Rivaroxaban (8.9%).

Crossing File C2 and SDO, 62% of patients in treatment with anticoagulants underwent hospitalisation (average duration of 10 days) and 22/43 patients showed potential drug-drug interactions mainly due to Warfarin. The average cost per hospitalisation was significantly greater for patients treated with Warfarin versus NOACs (€900 more).The lower economic impact of cases treated with NOACs versus Warfarin per DRG (€56 154 vs €201,743) as for admission to the ED (€1894 vs €6,952) were linked to the minor incidence of serious ADEs.

Conclusion Making a simulation, the potential saving would be proportional to the number of hospitalisations avoided, (€29,106,939). Despite the difference in cost of the therapies shifting from AVKs to NOACs, there could be a direct economic saving related to the lower incidence of hospitalization, and indirect from the reduction of ADE.

References and/or acknowledgements No conflict of interest.

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