Trends in oral anticoagulant prescription in patients with nonvalvular atrial fibrillation in Flanders and the impact of switching patients from vitamin K antagonists to DOACS in terms of the burden caused by complications of the disease: a registry-based study

Nakhoul, Elvire;Vaes, Bert;Mamouris, Pavlos;Degryse, Jean-Marie
(2022) Acta Clinica Belgica — p. 1-9 (2022)

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Authors
  • Nakhoul, Elvire
    Author
  • Vaes, Bert
    Author
  • Mamouris, Pavlos
    Author
  • Degryse, Jean-Marieorcid-logoUCLouvain
    Author
Abstract
Context: Since the introduction of direct oral anticoagulants (DOACs) for the treatment of nonvalvular atrial fibrillation (Afib), oral anticoagulants (OACs) prescription has evolved. Aim: We aim first to explore the OACs prescription behaviour in Flanders from 2002 to 2019 before exploring the impact of switching patients from vitamin K antagonists (VKAs) to DOACs in terms of the burden caused by stroke as a complication of non-valvular Afib. Methods: Data were obtained from INTEGO, a Flemish, general practice-based morbidity registration network. Comprised patients had at least one visit to their GP per year between 2002 and 2019 and a follow-up of at least 1 year after the diagnosis of Afib. Public prices were retrieved from the Belgian Centre for Pharmacotherapeutic Information (BCFI) and the National Institute for Health and Disability Insurance (RIZIV/ INAMI) sites. The number of Disability- Adjusted Life Years (DALYs) was based on the Global Burden of Disease (GBD) literature. The calculation of the Number Needed to Switch (NNSw) was the basis for conducting cost-utility analyses accounting for the global benefit in terms of the cost of prevented stroke/DALY and the cost of switching Flemish ≥ 65 years patients from VKAs to DOACs in two scenarios. Results: Increased DOAC use has been observed since 2012. The incremental cost effectiveness ratios (ICERs) yielded 553 to 824 €/DALY of prevented stroke. Conclusion: In this registry-based study, we found a significant positive trend in OAC use in Flanders between 2002 and 2019. Switching to DOACs seems cost-effective compared to a threshold of 20000€/DALY.
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Nakhoul, E., Vaes, B., Mamouris, P., & Degryse, J.-M. (2022). Trends in oral anticoagulant prescription in patients with nonvalvular atrial fibrillation in Flanders and the impact of switching patients from vitamin K antagonists to DOACS in terms of the burden caused by complications of the disease: a registry-based study. Acta Clinica Belgica, 1-9. https://doi.org/10.1080/17843286.2022.2123483 (Original work published 2022)