Utilizzo dei nuovi anticoagulanti orali nell’AULSS 9 di Treviso in relazione alle Linee di indirizzo Regionali: analisi di impatto economico e appropriatezza
Martina Donadi, Jenny Bolcato, Giovanni Berti
Introduction: Apixaban, Dabigatran and Rivaroxaban are new oral anticoagulants (NOACs) for the prevention of stroke and systemic embolism in Nonvalvular Atrial Fibrillation (NVAF), that offer advantages over warfarin including simplified dosing, fewer interactions, no requirement for monitoring. They can be delivered charged by the Health System if prescribed on web-based therapeutic plan by Specialists working in Centers authorized by Regions, in respect of eligibility criteria defined by Italian Health Authorities (AIFA), and can be delivered to patients either by Hospital Pharmacies or by Private Pharmacies on behalf of the Local Health Authority. Considering the innovation of NOACs and their higher cost vs Vitamin K Antagonists, besides the stringent definition of eligibility criteria by AIFA, the Veneto Region defined guidelines to optimize prescribing patterns.
Materials and Methods: All NOACs prescriptions, and the therapeutic plans received by the Hospital Pharmacy of AULSS 9 of Treviso and subscribed by authorized units, were collected and analysed from July 2013 through February 2015 in order to calculate the costs of treatments; besides, the analysis of appropriateness was performed evaluating a sample of eligibility records and verifying the criteria for patients enrolment with regard to Regional guidelines.
Results: In the analyzed period 928 patients were treated with NOACs, inducing a cost of 500.906 e. All authorized Centers acted by prescribing, bringing out that 29% of prescriptions came from Cardiology, 14% from Medicine and 13% from Cardiologists of Health Centers. The analysis of eligibility recorded that 30% of the patients were enrolled for the third criterion. Finally, the percentage of patients with NVAF that shifted from Vitamin K Antagonists to NOACs was 3%, and the new patients treated with NOACs represented 16% of new assisted with NVAF treated with oral anticoagulants.
Conclusions: The number of enrolled patients and the expenditure for NOACs resulted lower than expected; actually, the shift of patients with NVAF from Vitamin K Antagonists to NOACs is under control. To realize an effective monitoring of costs and check treatment appropriateness, it would be useful that Pharmacists obtain the access to Registers.
Key words: new oral anticoagulants, NOACs, stroke, systemic embolism in Nonvalvular Atrial Fibrillation, NVAF, Regional guidelines, costs of treatments