Impacto clínico y económico de la anticoagulación/ no anticoagulación en pacientes con fibrilación auricular no valvular en España
- Vivencio Barrios
- Isabel Egocheaga Cabello
- Olga Gavín Sebastián
- Alfonso Martín Martínez
- Javier Gallardo-Escudero
- Ana de las Heras Vidal
- Javier Soto Álvarez
- Ainara Echeto García
- Miguel Ángel Casado Gómez
- Sergio Cinza-Sanjurjo
ISSN: 0214-8986
Year of publication: 2022
Volume: 11
Issue: 2
Pages: 65-73
Type: Article
More publications in: Medicina general
Abstract
Objectives. To assess the clinical and economic impact of not treating with oral anticoagulants (OAC) patients with non-valvular atrial fibrillation (NVAF) who present a mediumhigh cardioembolic risk in Spain. Methods. A cost-consequence analysis was performed, estimating differences in cardioembolic events, major bleeding, all-cause mortality, potential years of life lost (PYLL), and associated costs, between a current scenario, which reflected the present situation in Spain with 37.4% of patients without anticoagulant treatment, compared to an alternative scenario, where the number of patients on anticoagulant treatment was increased, in order to comply with the recommendations of clinical guidelines. Target population, event rates and costs (€, 2021) were estimated from national sources. The perspective was of the National Health System with a time horizon of one year. Sensitivity analyses were performed to assess the robustness of the results. Results. A hypothetical cohort of 937,592 patients was analysed. Compared with the current scenario, treatment with OAC would prevent a total of 927, 1,854, 2,781 and 3,709 clinical events in the alternative scenario, depending on the increase in anticoagulated patients (25%, 50%, 75% and 100%, respectively), as well as a maximum of 195,598 PYLL. Avoided costs could reach €23,524,170. The results of the sensitivity analyses place the avoided costs at a maximum of €25,859,036. Conclusions. Increasing treatment with OAC in patients with NVAF and medium-high cardioembolic risk in Spain would generate better health outcomes and diminution of related costs, promoting a more efficient use of health resources