• Ahmed H Abdelhafiz and Nigel M Wheeldon.
• Department of Geriatric Medicine, Sheffield Teaching Hospitals, Sheffield, United Kingdom. ahmedhafiz@hotmail.com
• Am J Geriatr Pharmacother. 2003 Dec 1; 1 (2): 53-60.

BackgroundPatients with nonvalvular atrial fibrillation (NVAF) have often been excluded from long-term anticoagulant trials, and therefore patients in clinical practice may have different risk, compliance, and safety considerations from those usually included in such trials.ObjectiveThe aim of this study was to investigate the use of resources and cost implications of stroke prophylaxis with warfarin in NVAF patients in clinical practice.MethodsNew patients with NVAF referred to an anticoagulation clinic in the United Kingdom were interviewed in person at their first visit and then by telephone every 4 to 6 weeks by an investigator. They were asked about bleeding events and extra physician visits, procedures, or hospital admissions related to bleeding. They were also asked about the method and the cost of transportation to the anticoagulation clinic and the costs involved in days of work missed by the patient and caregiver. Costs of warfarin treatment consisted of the following: (1) cost of the drug, (2) cost of monitoring lie, international normalized ratio, traveling, nurse visits, work missed. postage), and (3) costs associated with complications (ie, bleeding-related physician visits, hospital admissions, related procedures). admissions, related procedures).ResultsA total of 402 patients were included. Mean (SD) age was 72.3 (10.3) years, and 224 patients (55.7%) were men. Mean (SD) follow-up was 19 (8.1) months (range, 1-31 months). Annual event rates were 1.7% (95% CI, 0.4-3.0) for major bleeding and 16.6% (95% CI, 13.0-20.2) for minor bleeding. The mean cost of warfarin treatment per patient per month was 11.0 pounds (95% CI, 10.2-11.6) in patients with no bleeding and 11.9 pounds (95% CI, 10.3-12.5) in patients with minor bleeding (P=NS). The cost was significantly higher in patients with major bleeding ( 299.0 pounds; 95% CI, 74.6-538.9; P<0.001). The total cost of warfarin treatment per patient per year was 159.4 pounds, and the cost to prevent 1 stroke per year was 5260.20 pounds.ConclusionIn clinical practice in the United Kingdom, anticoagulation with warfarin for prevention of ischemic stroke appeared to be cost-saving relative to the costs of stroke.

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