Budget Impact Analysis of Warfarin Reversal Therapies Among Hip Fracture Patients in Finland

Abstract

BackgroundHip fractures require operation within 36–48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches.MethodsFour reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC).ResultsWe estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland. The least costly treatment was vitamin K, which accounted for €289,000 in direct healthcare costs, and the most costly treatment option was warfarin cessation, which accounted for €1,157,000. In the budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with the current treatment mix.ConclusionThe various warfarin reversal strategies have different onset times, which may substantially impact the subsequent healthcare costs.

Is fast reversal and early surgery (within 24 h) in patients on warfarin medication with trochanteric hip fractures safe? A case-control study

“…This may allow surgery without major delay [ 10 ]. However, little is published in the literature on this topic and most of the authors who have studied the surgical management of patients on warfarin do not differentiate between different types of hip fractures or surgical methods [ 7 , 11 ].…”

Minimizing bleeding risk in patients receiving direct oral anticoagulants for stroke prevention

“…Dose cessations or reductions are limited in terms of sensitivity, not appropriate for all patients, and may not offer the best cost–benefit balance owing to impacts on treatment effectiveness. Estimates from studies on warfarin reversal in hip replacement surgery have shown dose cessation to be the most expensive approach when direct costs arising during hospitalization are accounted for; 57 low-dose PCC has also been shown to be cost effective for management of VKA-induced bleeding versus a variable high-dose strategy. 58 However, a recent study suggests that management of dabigatran-associated major bleeding with dose cessation is as effective as or superior to drug withdrawal plus administration of red cell concentrates, plasma, or coagulation factor concentrates.…”

CORR Insights®: Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?

“…Different approaches for warfarin reversal in patients with hip fracture have been suggested [1,2,[5][6][7][8]10]. Available options include prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), and vitamin K [7].…”

“…As of today, there are no widely accepted guidelines for pharmacologic reversal of warfarin in patients requiring hip fracture surgery. Some authors suggested administration of vitamin K as a safe, effective, and cost-efficient method of reversing warfarin in patients undergoing hip fracture surgery [1,[5][6][7][8]. However, the ideal dosage, dosing schedule, and route of administration (oral versus subcutaneous or intravenous) remain unknown.…”

“…Similarly, the role of bridging therapy with heparin or low molecular weight heparins needs to be defined in future studies. Finally, any warfarin reversal protocol must be evaluated for its cost-efficiency [7].…”