ORIGINAL ARTICLE   

Minerva Cardioangiologica 2018 February;66(1):1-5

DOI: 10.23736/S0026-4725.17.04500-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Budget impact analysis of rivaroxaban vs. warfarin anticoagulation strategy for direct current cardioversion in non-valvular atrial fibrillation patients: the MonaldiVert Economic Study

Vincenzo RUSSO ¹, Anna RAGO ¹, Andrea A. PAPA ¹ ✉, Valter BIANCHI ², Vincenzo TAVOLETTA ², Stefano DE VIVO ², Ciro CAVALLARO ², Gerardo NIGRO ¹, Antonio D’ONOFRIO ²

¹ Department of Cardiology, L. Vanvitelli University of Campania, Naples, Italy; ² Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy

BACKGROUND: Rivaroxaban is the first novel oral anticoagulant to receive regulatory approval for non-valvular atrial fibrillation (NVAF) patients who require cardioversion. The MonaldiVert real life experience showed positive benefit-risk profile of short term rivaroxaban administration for transesophageal echocardiogram guided cardioversion in patients who had not achieved adequate pre-procedural vitamin K antagonist (VKA) anticoagulation.
METHODS: Aim of our study was to perform a budget impact analysis of MonaldiVert anticoagulation strategy for direct current cardioversion in NVAF patients and to compare the following costs borne by the Regional Healthcare System (RHS) with those for a hypothetical cohort of identical patients underwent from the beginning to early rivaroxaban treatment before direct current cardioversion.
RESULTS: The mean costs per each NVAF patient treated with VKA strategy and rivaroxaban rescue strategy were € 134.53 and € 189.83, respectively. Considering a hypothetical scenario in which all study population would be treated from the beginning with rivaroxaban (rivaroxaban early strategy), the mean cost per patient would have been € 81.11. The total cost borne by the RHS, including the cost of the cardioversion procedure, for the two therapeutic strategies carried out at Monaldi Hospital (VKA strategy and Rivaroxaban rescue strategy) was € 88,458.53. The total cost would be borne by the RHS for rivaroxaban early strategy, if applied to all study population, would have been € 69,989.15 with a saving of € 18,469.38 compared to the actually applied strategy.
CONCLUSIONS: Rivaroxaban rescue strategy for transesophageal echocardiography guided direct current cardioversion in NVAF patients, who had not achieved adequate pre-procedural VKA anticoagulation, is an effective and safe strategy, which allows to not delay the procedure, reducing times and wastage of cardioversion slots, without substantial costs increase.

KEY WORDS: Rivaroxaban - Anticoagulants - Electric countershock - Budgets - Cost-benefit analysis - Delivery of health care