Russo Vincenzo, Rago Anna, Papa Andrea A, Bianchi Valter, Tavoletta Vincenzo, DE Vivo Stefano, Cavallaro Ciro, Nigro Gerardo, D'Onofrio Antonio
Department of Cardiology, L. Vanvitelli University of Campania, Naples, Italy.
Department of Cardiology, L. Vanvitelli University of Campania, Naples, Italy -
Minerva Cardioangiol. 2018 Feb;66(1):1-5. doi: 10.23736/S0026-4725.17.04500-5. Epub 2017 Sep 25.
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.
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.
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.
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.
利伐沙班是首个获监管批准用于需要心脏复律的非瓣膜性心房颤动（NVAF）患者的新型口服抗凝药。MonaldiVert的真实生活经验表明，对于术前未达到充分维生素K拮抗剂（VKA）抗凝的患者，短期应用利伐沙班进行经食管超声心动图引导下心脏复律具有良好的效益风险比。
我们研究的目的是对MonaldiVert抗凝策略用于NVAF患者直流电复律进行预算影响分析，并将地区医疗系统（RHS）承担的以下成本与一组假设的相同患者队列的成本进行比较，该队列从一开始就在直流电复律前接受早期利伐沙班治疗。
采用VKA策略和利伐沙班挽救策略治疗的每名NVAF患者的平均成本分别为134.53欧元和189.83欧元。考虑到一种假设情景，即所有研究人群从一开始就接受利伐沙班治疗（利伐沙班早期策略），则每名患者的平均成本将为81.11欧元。Monaldi医院实施的两种治疗策略（VKA策略和利伐沙班挽救策略），RHS承担的总成本，包括复律程序的成本，为88,458.53欧元。如果将利伐沙班早期策略应用于所有研究人群，RHS承担的总成本将为69,989.15欧元，与实际应用的策略相比节省18,469.38欧元。
对于术前未达到充分VKA抗凝的NVAF患者，采用利伐沙班挽救策略进行经食管超声心动图引导下直流电复律是一种有效且安全的策略，可避免延迟手术，减少复律时段的时间和浪费，且成本没有大幅增加。
