Increased prescribing of oral anticoagulants for patients with atrial fibrillation (AF) has increased drug costs but has saved the NHS millions of pounds, according to a study published in the journal Heart.
The study, carried out by researchers from the Health Economics Unit and University of Leeds, used data on AF prevalence, AF-related stroke incidence and prescribing for all NHS general practices, hospitals and registered patients with hospitalised AF-related stroke in England from national databases. Stroke care costs were based on published data. The study compared changes in oral anticoagulation prescribing (warfarin or direct oral anticoagulants [DOACs]), incidence of hospitalised AF-related stroke and associated overall and per-patient costs in the periods January 2011-June 2014 and July 2014-December 2017.
The data showed that between 2011-2014 and 2014-2017, recipients of oral anticoagulation for AF increased by 86.5 per cent from 1,381,170 to 2,575,669. The number of patients prescribed warfarin grew by 16.1 per cent from 1,313,544 to 1,525,674 and those taking DOACs increased by over 1400.0 per cent from 67,626 to 1,049,995.
Prescribed items increased by 5.9 per cent for warfarin (95% CI, 2.9-8.9%) but by over 2000.0 per cent for DOACs (95% CI, 1848.8-2160.7%).
Oral anticoagulation prescription cost rose overall by 781.2 per cent, from over £87 million to almost £769 million. The cost per patient increased by 50.7 per cent from £293 to £442, giving an incremental cost of £149.
However, as AF-related stroke incidence fell by 11.3 per cent (95% CI, −11.5 to −11.1%) from 86,467 in 2011-2014 to 76,730 in 2014-2017, when adjusted for AF prevalence, the overall per-patient cost reduced from £1129 to £840, giving an incremental per-patient saving of £289.
This study shows that, despite nearly one million additional DOAC prescriptions and substantial associated spending in the latter part of the study, the decline in AF-related stroke led to incremental savings at the national level.
