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Datta SK, Yoon J, McDuffie JR, Williams Jr JW. Budget Impact Analysis: Warfarin and Newer Oral Anticoagulants for the Prevention of Stroke Among Veterans with Atrial Fibrillation. VA-ESP Project #09-010. Prepared for QUERI by Evidence-based Synthesis Program (ESP) Center, Durham, NC Durham Veterans Affairs Healthcare System. 2013 Aug 1.
A systematic literature review and meta-analysis by the Durham Veterans Affairs (VA) Evidence-based Synthesis Program (ESP), in addition to research by others, has shown that newer anticoagulants can potentially improve stroke prevention among patients with atrial fibrillation (AF). This systematic review estimated lower all-cause mortality (risk ratio 0.88; risk difference 8 fewer deaths per 1000 treated patients) and fewer hemorrhagic strokes (risk ratio 0.48; 95% CI, 0.36 to 0.62) compared with adjusted-dose warfarin. Although the newer anticoagulants are expensive, economic analyses have shown that for certain subgroups of patients with AF, these newer anticoagulants are cost-effective under the traditional threshold of $50,000 per quality-adjusted life year saved. Inclusion of newer anticoagulants in the VA formulary may improve stroke prevention for Veterans with AF but may also lead to a dramatic increase in drug expenditure. However, some of the increased drug expenditure may be mitigated by reductions in other forms of healthcare expenditures inherent with warfarin use, such as reductions in long-term costs associated with stroke care. Thus, we conducted a budget impact analysis (BIA) from the perspective of the VA healthcare system, under different plausible drug access scenarios, in order to assess the potential overall annual budget impact of including newer anticoagulants in the VA formulary for stroke prevention in Veterans with AF.
