Comparison of direct costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation during preparation for elective cardioversion in the real clinical practice

Abstract

Aim. To compare direct medical costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation (NVAF) during preparation for elective cardioversion. Material and methods. An open non-randomized study was conducted to evaluate direct medical costs (cost of drug, cost of the international normalized ratio (INR) adjustment in outpatient clinic, cost of visits to cardiologist). Patients (n=62) with persistent NVAF (AF paroxysm duration > 48 hours) were enrolled. All of them requested medical assistance and were decided to perform an elective cardioversion. The patients received warfarin (n = 32) or dabigatran (n = 30). The patients of the both groups were similar in the main clinical characteristics and thromboembolic risk levels according to CHA2DS2-VASc scale. Results. Treatment duration before elective cardioversion was 21±2 and 30.5±4.5 days for dabigatran and warfarin groups, respectively (p < 0.05). Average costs of visits to cardiologists were 3,720 and 744 RUB in warfarin and dabigatran groups, respectively (p < 0.05), and drug costs were 53.63 and 1,172.01 RUB, respectively (p < 0.05). The costs of laboratory INR monitoring were 3,058 RUB in warfarin group. Total costs per patient were 6,831.63 and 1,916.01 RUB in warfarin and dabigatran groups, respectively (p < 0.05). Conclusion. In the real clinical practice in patients with NVAF dabigatran antithromboembolic therapy substantially reduces direct medical costs in comparison with warfarin therapy during preparation for elective cardioversion. Dabigatran therapy reduces time from the decision of elective cardioversion and antithromboembolic therapy start to cardioversion performance.