Background: When assessing the cost-effectiveness ratio of New Oral Anticoagulants vs VKA, the total cost of managing patients with VKA is a key parameter of the result, since it determines the cost-differential between the two treatments which will apply to all patients who are treated. In France, the management of patients with VKA is not optimal, with many publications estimating that average time to target is 50%. The actual cost of managing patients with VKAs is not well known, as well as its effectiveness in terms of Time to Target. Objectives: To calculate what extra cost would be need in France for patients with VKA to reach the Time to Target observed in the clinical trials comparing them to NOAC; to estimate the loss of preventive effectiveness associated to an under-optimal management leading to a Time to Target of 50%. Methods: Two hypothetical models were designed, based on plausible assumptions and literature review. Results: Based on a strengthened coordination between general practitioners, laboratories and nurses, the extra cost per year needed to reach Time to Target similar to what was observed in the clinical trials of NOAC, would be €48 or €103 per year, according to the different organisational solutions. This extra cost would represent a relative increase of 17% to 39% relative to present sub-optimal management. If real life Time to Target was 50%, then this would represent a relative loss of preventive effectiveness of 16.7% of VKA compared to what was observed in clinical trials. Conclusion: When estimating the cost-effectiveness of NOAC compared to VKA, one should consider the extra cost to be invested to reach a level of quality of the management of VKA similar as to what was observed in trials. If not, then one should consider modelling a lower effectiveness of VKA.
PUYOU DE POUVOURVILLE, G. (2016). Comment Améliorer le Suivi des AVK et pour quel Coût? Archives of Cardiovascular Diseases Supplements, 2(8), pp. 169-173.