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Implementing Guidelines: The Cost and Clinical Impact of Anticoagulants in the UK Atrial Fibrillation Population

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Abstract

Background

Updated treatment guidelines for atrial fibrillation (AF) have been released by the National Institute for Health and Care Excellence (NICE) in the UK, and highlight a current shortfall in the prescription of anticoagulants to patients with AF for stroke prevention.

Objective

To design a budget impact model as a planning tool for UK Clinical Commissioning Groups (CCGs) looking to budget for greater use of anticoagulants in the AF population.

Methods

An Excel® model was developed to estimate the five-year impact of gradually treating all eligible patients with AF who are currently not being prescribed anticoagulants, both in terms of the effect on key clinical outcomes (strokes, major bleeds and mortality) and the associated financial impact.

Results

For a population of 251,693 (average CCG size) with an estimated 2626 prevalent patients and an additional 546 incident cases annually, the model estimated that increasing the proportion of the eligible AF patient population receiving anticoagulation by a fraction would require an additional budget of GBP139,961 in Year 1 to treat an additional 314 patients. This would rise to GBP1,004,900 in Year 5 to treat an additional 2242 patients, with all eligible patients treated by this year. The price year was 2014. Over the 5-year timeframe, this could lead to the prevention of 24 strokes and 29 deaths, with an increase of 31 major bleeds.

Conclusions

The clinical benefits of appropriate anticoagulation are widely recognised; however, full implementation can be difficult and costly. Therefore, the development of models can support the planning process by facilitating discussion among stakeholders on how best they can reach full implementation. The model is flexible and can be adapted to suit different payers.

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Compliance with ethical standards

No funding was received for this manuscript or the economic model discussed. Shields GE and Chapman A-M have previously undertaken work as employees of BresMed, which has been paid as a consultancy to work in a similar area. This previous work involved a general review on the challenges of anticoagulation in a UK setting to assess the value of novel oral anticoagulants and was funded by Pfizer and Bristol-Myers Squibb, who market the novel oral anticoagulant apixaban. Bates AE has no conflicts of interest related to this study

Author contributions

Shields GE and Chapman A-M were involved in the planning, completion and interpretation of the results of the economic model, including the literature searches to identify inputs. Shields GE wrote the paper, with Chapman A-M and Bates AE provided reviews and made revisions to draft. All authors approved the final submitted version and guaranteed its content.

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Correspondence to Gemma E. Shields.

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Shields, G.E., Bates, A.E. & Chapman, AM. Implementing Guidelines: The Cost and Clinical Impact of Anticoagulants in the UK Atrial Fibrillation Population. Appl Health Econ Health Policy 13, 543–551 (2015). https://doi.org/10.1007/s40258-015-0180-7

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