Comparing Total Medical Costs between Patients Receiving Direct Oral Anticoagulants Versus Warfarin for the Treatment of Atrial Fibrillation: Evidence from the VA

摘要

Atrial fibrillation (AFib) is the second most common cardiovascular condition affecting up to 6.1 million individuals in the United States. Treatment of AFib focuses on preventing blood clots to reduce stroke risk. Traditionally, warfarin, a vitamin‐k antagonist, has been used to reduce stroke risk by two‐thirds. However, warfarin requires regular laboratory monitoring to ensure safety and efficacy, and may be cumbersome for patients. Newer direct oral anticoagulants (DOACs) are an alternative treatment and do not require laboratory monitoring due to their more predictable pharmacokinetics. DOACs are either noninferior or superior to warfarin on a variety of outcomes and may be cost‐effective for certain patient populations. Much of the evidence demonstrating benefits of DOACs over warfarin have been in clinical trial settings, which may have limited generalizability to real‐world practice. For example, patients enrolled in the Veterans Affairs (VA) Health care System have increased burden of illness and greater socioeconomic challenges relative to other populations. This study examined whether advantages of DOACs found in prior trials translated to the VA population by comparing total downstream costs between AFib patients treated with warfarin and DOACs.