Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study.
<h4>Objectives</h4>Currently, two classes of oral anticoagulants are available in nursing home residents: vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). DOACs have a higher net clinical benefit than VKAs but DOACs are about 10 times more expensive than VKAs. The objec...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0283604 |
| _version_ | 1797843210020585472 |
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| author | George Pisica-Donose Matthieu Piccoli Bastien Genet Stéphane Bouee Stefan Berechet Ion Berechet Antonin Dacasa Cortes Sabri Atsamena Catherine Bayle Mihai Badescu François Catelain Lynda Kermeche Isabelle Merlier Sahondranirina Rakotoniary Valérie Savin Ariane Vidal Jean-Sébastien Vidal Olivier Hanon |
| author_facet | George Pisica-Donose Matthieu Piccoli Bastien Genet Stéphane Bouee Stefan Berechet Ion Berechet Antonin Dacasa Cortes Sabri Atsamena Catherine Bayle Mihai Badescu François Catelain Lynda Kermeche Isabelle Merlier Sahondranirina Rakotoniary Valérie Savin Ariane Vidal Jean-Sébastien Vidal Olivier Hanon |
| author_sort | George Pisica-Donose |
| collection | DOAJ |
| description | <h4>Objectives</h4>Currently, two classes of oral anticoagulants are available in nursing home residents: vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). DOACs have a higher net clinical benefit than VKAs but DOACs are about 10 times more expensive than VKAs. The objective of our study was to assess and compare the overall costs of anti-coagulant strategy (VKA or DOAC), i.e., including drugs, laboratory costs and time spent in human capital (nurses and medical time) in nursing homes in France.<h4>Methods</h4>This was an observational, multicenter, prospective study including nine nursing homes in France. Among these nursing homes, 241 patients aged 75 years and older and treated with VKA (n = 140) or DOAC (n = 101) therapy accepted to participate in the study.<h4>Results</h4>During the 3-month follow-up period, the adjusted mean costs per patient were higher for VKA than DOACs for nurse care (€327 (57) vs. €154 (56), p<.0001) for general practitioner care (€297 (91) vs. €204 (91), p = 0.02), for coordinating physicians care (€13 (7) vs. €5 (7), p < 0.07), for laboratory tests (€23 (5) vs. €5 (5), p<.0001), but were lower for drug costs (€8 (3) vs. €165 (3), p<.0001). The average overall cost for 3 months per patient was €668 (140) with VKA vs. €533 (139) with DOAC (p = 0.02).<h4>Conclusion</h4>Our study showed that in nursing homes despite a higher drug cost, DOAC therapy is associated with a lower total cost and less time used by nurses and physicians for drug monitoring when compared to VKA. |
| first_indexed | 2024-04-09T17:01:12Z |
| format | Article |
| id | doaj.art-e5955af99f4a41a287ccbc5bc705b80b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T17:01:12Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e5955af99f4a41a287ccbc5bc705b80b2023-04-21T05:32:35ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01184e028360410.1371/journal.pone.0283604Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study.George Pisica-DonoseMatthieu PiccoliBastien GenetStéphane BoueeStefan BerechetIon BerechetAntonin Dacasa CortesSabri AtsamenaCatherine BayleMihai BadescuFrançois CatelainLynda KermecheIsabelle MerlierSahondranirina RakotoniaryValérie SavinAriane VidalJean-Sébastien VidalOlivier Hanon<h4>Objectives</h4>Currently, two classes of oral anticoagulants are available in nursing home residents: vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC). DOACs have a higher net clinical benefit than VKAs but DOACs are about 10 times more expensive than VKAs. The objective of our study was to assess and compare the overall costs of anti-coagulant strategy (VKA or DOAC), i.e., including drugs, laboratory costs and time spent in human capital (nurses and medical time) in nursing homes in France.<h4>Methods</h4>This was an observational, multicenter, prospective study including nine nursing homes in France. Among these nursing homes, 241 patients aged 75 years and older and treated with VKA (n = 140) or DOAC (n = 101) therapy accepted to participate in the study.<h4>Results</h4>During the 3-month follow-up period, the adjusted mean costs per patient were higher for VKA than DOACs for nurse care (€327 (57) vs. €154 (56), p<.0001) for general practitioner care (€297 (91) vs. €204 (91), p = 0.02), for coordinating physicians care (€13 (7) vs. €5 (7), p < 0.07), for laboratory tests (€23 (5) vs. €5 (5), p<.0001), but were lower for drug costs (€8 (3) vs. €165 (3), p<.0001). The average overall cost for 3 months per patient was €668 (140) with VKA vs. €533 (139) with DOAC (p = 0.02).<h4>Conclusion</h4>Our study showed that in nursing homes despite a higher drug cost, DOAC therapy is associated with a lower total cost and less time used by nurses and physicians for drug monitoring when compared to VKA.https://doi.org/10.1371/journal.pone.0283604 |
| spellingShingle | George Pisica-Donose Matthieu Piccoli Bastien Genet Stéphane Bouee Stefan Berechet Ion Berechet Antonin Dacasa Cortes Sabri Atsamena Catherine Bayle Mihai Badescu François Catelain Lynda Kermeche Isabelle Merlier Sahondranirina Rakotoniary Valérie Savin Ariane Vidal Jean-Sébastien Vidal Olivier Hanon Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. PLoS ONE |
| title | Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. |
| title_full | Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. |
| title_fullStr | Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. |
| title_full_unstemmed | Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. |
| title_short | Medico-economic comparison of two anticoagulant treatment strategies: Vitamin K antagonists vs. direct oral anticoagulants in older adults in nursing homes in France. The "MIKADO" study. |
| title_sort | medico economic comparison of two anticoagulant treatment strategies vitamin k antagonists vs direct oral anticoagulants in older adults in nursing homes in france the mikado study |
| url | https://doi.org/10.1371/journal.pone.0283604 |
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