Patient’s time and travel costs in the treatment of atrial fibrillation: Savings achievable with the shift from warfarin to new oral anticoagulants

Authors: Aapeli Leminen*, University of Eastern Finland, Mikko Pyykönen, University of Eastern Finland, Markku Tykkyläinen, University of Eastern Finland, Tiina Laatikainen, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Joint municipal authority for North Karelia social and health services, Joensuu, Finland; Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
Topics: Medical and Health Geography, Geographic Information Science and Systems, Spatial Analysis & Modeling
Keywords: atrial fibrillation, warfarin therapy, travel costs, NOAC, patient database, georeferenced cost model
Session Type: Paper
Day: 4/4/2019
Start / End Time: 9:55 AM / 11:35 AM
Room: Madison A, Marriott, Mezzanine Level
Presentation File: No File Uploaded


Atrial fibrillation (AF) is the most common arrhythmic condition in developed countries and it increases healthcare expenditure. The primary form of anticoagulation therapy, warfarin, has a risk of thrombotic and hemorrhagic events, so it requires regular monitoring with a blood test. For example, In Finland a patient using warfarin travels to a clinic for blood test on average 15 times per year. Indirect healthcare costs, such as travel and time costs are often ignored in economic evaluations, even though they may be considerable to both society and patients. In our study we develop a georeferenced cost model that measures travel and time costs associated with warfarin therapy. We also investigate whether savings could be achieved by replacing warfarin with comparably effective new oral anticoagulants (NOAC) that are more expensive but do not require any monitoring. The model is applied to a Finnish public healthcare setting in North Karelia (166 000 inhabitants). Data consists of individual level patient data (10 363 AF patients) from the regional patient database and GIS data such as digital road network data and zip code area-level income data. Our preliminary results indicate that the share of the travel and time costs in warfarin monitoring is 26.5% in our study region. Additionally, with current drug retail prices in Finland the expense of anticoagulation therapy is already similar with both warfarin and NOACs even when indirect costs of warfarin are considered. When the drug prices decrease in the future, NOAC therapy becomes even more viable and cost-effective option.

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