Warfarin in the secondary prevention of thromboembolism in atrial fibrillation: impact of bioavailability on costs and outcomes

PharmacoEconomics
Nicole MittmannWilliam R Bartle

Abstract

The bioavailability of warfarin is an important factor affecting the achievement of therapeutic anticoagulation. It is uncertain whether less expensive generic preparations of warfarin would compromise prevention of thromboembolism or increase bleeding risk in patients with atrial fibrillation. To compare the cost effectiveness of strategies using warfarin products with variable bioavailability in patients with a prior stroke or transient ischaemic attack related to atrial fibrillation. A Markov decision-analytic model simulating health and economic outcomes over 1 year using the perspective of a government provincial payer was created. Four strategies were compared (where F = 1 is the assumed bioavailability of the branded/reference product): (i) warfarin F = 1; (ii) warfarin F = 1.25; (iii) warfarin F = 0.80; and (iv) alternating warfarin F = 1.25 and 0.80 every other month. Direct medical costs for drugs, physician fees, laboratory testing and hospitalisation for morbid events were obtained from a government payer, a local accounting system and the medical literature. The cost of warfarin F = 1 was equivalent to the cost of the brand name warfarin and the cost of warfarin F not equal 1 was equivalent to generic warfarin. In ...Continue Reading

References

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Citations

Dec 5, 2006·Current Opinion in Cardiology·Yaariv Khaykin
Aug 2, 2007·Journal of Cardiovascular Electrophysiology·Yaariv KhaykinCharles R Kerr
Mar 22, 2012·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Walter P WodchisDante Morra
May 26, 2005·The Annals of Pharmacotherapy·Jennifer A PereiraJeffrey S Ginsberg
Dec 26, 2008·Stroke; a Journal of Cerebral Circulation·Ramon Luengo-FernandezPeter M Rothwell

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