Costs of minor bleeds in atrial fibrillation patients using a non-vitamin K antagonist oral anticoagulant

Abstract

Background

A very common side effect of non-vitamin K antagonist oral anticoagulant (NOAC) is (minor) bleeding. Data about impact and costs of minor bleeds in NOAC therapy is still limited or not present in current literature. In this patient orientated study, we aim to provide an estimate of the costs of minor bleeds in patients with atrial fibrillation (AF) treated with a NOAC.

Methods

A retrospective observational cohort study was conducted. Patients with AF and on NOAC therapy were included. Data was obtained by questionnaires and information from electronic patient records. Reference prices were used to calculate the costs per patient. Furthermore, cost of minor bleeds per patient is compared with literature-based costs of minor and major bleeding.

Results

139 patients were included. A total of 94 minor bleed were reported by 71 patients. The sum of minor bleeding costs from societal perspective were €9,851.49, or on average €70,87 (95% CI €54,37– €85,68) per patient with AF. The biggest cost drivers were rectal and vaginal bleeds, epistaxis was most commonly reported.

Conclusion

Total costs of minor bleeds from a societal perspective, in AF patients using NOACs, are non-trivial and exceed the costs presented in existing literature.

Keywords:

• Anticoagulant agents
• bleeding
• health care costs
• atrial fibrillation
• Netherlands

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has disclosed the following, although none are specific to this manuscript: Consulting fees from Abbott, AbbVie, ACI Clinical, Alexion Pharmaceuticals, Aplagon Ltd, Bayer, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, BTG, Cambridge Healthcare Research, Daiichi-Sankyo, EmstoPA Ltd, EPG Health, Guidepoint Global, Gulf Coast Developments, Janssen, Johnson & Johnson, Leo Pharma, LifeSciences Consulting, Medscape, McKinsey, Navigant, North Star Communications, ONO Pharmaceuticals, Pfizer, Portola Pharmaceuticals, Sanofi, Takeda, Total CME, Windrose Consulting Group; advisory board membership with Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Johnson and Johnson, Pfizer, Portola, Sanofi; payments for lectures, payments for preparation of reports and payment for development of educational presentations from Aspen, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Johnson & Johnson, Medscape, Pfizer and Portola. They have advised the UK Government Health Select Committee, the all-party working group on thrombosis, the Department of Health, and the NHS, on the prevention of VTE. He is also an advisor to Lifeblood: the thrombosis charity and is the founder of the European educational charity the Coalition to Prevent Venous Thromboembolism. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Acknowledgements

None stated.