Trends in oral anticoagulant prescription in patients with nonvalvular atrial fibrillation in Flanders and the impact of switching patients from vitamin K antagonists to DOACS in terms of the burden caused by complications of the disease: a registry-based study.

IF 1.6 4区 医学 Q2 Medicine
Elvire Nakhoul, Bert Vaes, Pavlos Mamouris, Jean-Marie Degryse
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Abstract

Context: Since the introduction of direct oral anticoagulants (DOACs) for the treatment of nonvalvular atrial fibrillation (Afib), oral anticoagulants (OACs) prescription has evolved.

Aim: We aim first to explore the OACs prescription behaviour in Flanders from 2002 to 2019 before exploring the impact of switching patients from vitamin K antagonists (VKAs) to DOACs in terms of the burden caused by stroke as a complication of non-valvular Afib.

Methods: Data were obtained from INTEGO, a Flemish, general practice-based morbidity registration network. Comprised patients had at least one visit to their GP per year between 2002 and 2019 and a follow-up of at least 1 year after the diagnosis of Afib. Public prices were retrieved from the Belgian Centre for Pharmacotherapeutic Information (BCFI) and the National Institute for Health and Disability Insurance (RIZIV/ INAMI) sites. The number of Disability-Adjusted Life Years (DALYs) was based on the Global Burden of Disease (GBD) literature. The calculation of the Number Needed to Switch (NNSw) was the basis for conducting cost-utility analyses accounting for the global benefit in terms of the cost of prevented stroke/DALY and the cost of switching Flemish ≥ 65 years patients from VKAs to DOACs in two scenarios.

Results: Increased DOAC use has been observed since 2012. The incremental cost effectiveness ratios (ICERs) yielded 553 to 824 €/DALY of prevented stroke.

Conclusion: In this registry-based study, we found a significant positive trend in OAC use in Flanders between 2002 and 2019. Switching to DOACs seems cost-effective compared to a threshold of 20000€/DALY.

弗兰德斯非瓣膜性房颤患者口服抗凝处方的趋势以及从疾病并发症引起的负担方面从维生素K拮抗剂转向DOACS的影响:一项基于登记的研究
背景:自引入直接口服抗凝剂(DOACs)治疗非瓣膜性心房颤动(Afib)以来,口服抗凝剂(OACs)处方也发生了变化。目的:我们首先探讨2002年至2019年佛兰德斯地区OACs处方行为,然后探讨从维生素K拮抗剂(vka)转向DOACs对非瓣膜性房颤并发症卒中造成的负担的影响。方法:数据来自INTEGO,一个佛兰德全科医生为基础的发病率登记网络。纳入的患者在2002年至2019年期间每年至少去一次全科医生,并在诊断为Afib后至少随访1年。从比利时药物治疗信息中心(BCFI)和国家健康和残疾保险研究所(RIZIV/ INAMI)网站检索公共价格。残疾调整生命年(DALYs)的数量基于全球疾病负担(GBD)文献。转换所需数量(NNSw)的计算是进行成本效用分析的基础,该分析考虑了在两种情况下预防卒中/DALY成本和将佛兰德≥65岁患者从vka转换为doac的成本方面的全球收益。结果:自2012年以来,DOAC的使用有所增加。增量成本效益比(ICERs)产生553至824欧元/年预防中风。结论:在这项基于登记的研究中,我们发现2002年至2019年期间佛兰德斯地区OAC的使用呈显著的积极趋势。与20000欧元/年的门槛相比,切换到doac似乎具有成本效益。
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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