Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Rev Esp Cardiol (Engl Ed). 2021 Sep;74(9):773-780. doi: 10.1016/j.rec.2020.06.033. Epub 2020 Sep 24.
The aim of this analysis was to evaluate the burden and cost of complications due to poor anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKA) in Spain.
An analytical model was used to estimate annual differences in ischemic stroke, major bleeding, deaths, costs, and potential years of life lost between patients with poor anticoagulation control (time in therapeutic range <65%) and adequate control (time in therapeutic range ≥ 65%) with a 1-year time horizon. Information on the target population (patients ≥ 65 years), event rates, and costs were obtained from national sources. Direct costs in euros (2018) were included from the perspective of the national health system (NHS) and direct and indirect costs from the societal perspective. A sensitivity analysis was performed with post-hoc data from the SPORTIF III/V trials.
We analyzed a hypothetical cohort of 594 855 patients, 48.3% with poor anticoagulation control, with an increase of 2321 ischemic strokes, 2236 major bleeding events and 14 463 deaths, and an annual incremental cost between €29 578 306 from the NHS perspective and €75 737 451 from the societal perspective. The annual impact of mortality was 170 502 potential years of life lost. The results of the sensitivity analysis showed that the annual cost would reach €97 787 873 from the societal perspective.
Poor anticoagulation control with AVK has a strong impact on loss of health and on increased spending for the NHS.
本分析旨在评估西班牙使用维生素 K 拮抗剂（VKA）治疗非瓣膜性心房颤动（NVAF）患者抗凝控制不佳导致并发症的负担和成本。
使用分析模型估计抗凝控制不佳（治疗范围内时间<65%）和充分控制（治疗范围内时间≥65%）患者在 1 年内缺血性中风、大出血、死亡、成本和潜在寿命损失方面的年度差异。目标人群（≥65 岁患者）、事件发生率和成本的信息来自国家来源。包括来自国家卫生系统（NHS）的直接成本（2018 年欧元）和来自社会视角的直接和间接成本。使用 SPORTIF III/V 试验的事后数据进行敏感性分析。
我们分析了一个假设的 594855 名患者队列，48.3%的患者抗凝控制不佳，导致 2321 例缺血性中风、2236 例大出血事件和 14463 例死亡，NHS 视角下的年度增量成本为 29578306 欧元，从社会角度来看，年度增量成本为 75737451 欧元。死亡率的年影响为 170502 潜在寿命损失年。敏感性分析的结果表明，从社会角度来看，年度成本将达到 97787873 欧元。
AVK 的抗凝控制不佳对健康损失和 NHS 支出增加有重大影响。
