NDLI: Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom.

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Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom.

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Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Guest, Julian F. Watson, Henry G. Limaye, Sameer
Description	Country affiliation: United kingdom Author Affiliation: Guest JF ( Catalyst Health Economics Consultants, Northwood, Middlesex, United Kingdom. julian.guest@catalyst-health.co.uk)
Abstract	BACKGROUND: Warfarin is the most commonly used oral anticoagulant in the United Kingdom. Indications for its long-term use include recurrent venous thrombosis, prosthetic heart valves, stroke prevention in atrial fibrillation, valvular heart disease, and prosthetic heart valve replacement. OBJECTIVE: The aim of this study was to estimate the cost-effectiveness of using prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for emergency warfarin reversal in patients with a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. METHODS: Mortality estimates associated with managing an intracranial, gastrointestinal, or retroperitoneal hemorrhage were obtained from published studies after a systematic literature search. Estimates of health care resource use pertaining to managing warfarin-treated patients after a life-threatening hemorrhage were provided by 11 consultant physicians with experience in warfarin reversal. These published clinical outcomes and clinician-derived health care resource use estimates were used to construct a decision model depicting the treatment patterns and associated resource use attributable to current management of a hypothetical cohort of adults undergoing emergency warfarin reversal as a result of an intracranial, gastrointestinal, or retroperitoneal hemorrhage in the United Kingdom. The model only considered direct health care costs borne by the secondary care sector of the National Health Service, and not those borne in the community (with the exception of the cost of stroke rehabilitation) and estimated the cost effectiveness of using PCC compared with FFP to reverse the anticoagulant effects of warfarin, from the perspective of the National Health Service, at 2007-2008 prices. RESULTS: The cost of warfarin reversal was estimated to be ≤ 15% of the total cost of managing a patient after a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. The cost per life-year gained with PCC was estimated to range from £1000 to £2000, depending on hemorrhage type (ie, intracranial, gastrointestinal, or retroperitoneal). The cost per quality-adjusted life-year gained with PCC was estimated at £3000 or less depending on hemorrhage type. CONCLUSION: PCC appeared to be a more cost-effective treatment than FFP for the emergency reversal of warfarin, from the perspective of the UK National Health Service, in this model analysis.
File Format	HTM / HTML
ISSN	01492918
Issue Number	14
Volume Number	32
e-ISSN	1879114X
Journal	Clinical Therapeutics
Language	English
Publisher	Elsevier
Publisher Date	2010-12-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Anticoagulants Adverse Effects Blood Coagulation Factors Economics Emergency Medical Services Models, Economic Plasma Warfarin Aged Administration & Dosage Therapeutic Use Blood Component Transfusion Methods Cost-benefit Analysis Decision Trees Statistics & Numerical Data Hemorrhage Chemically Induced Mortality Therapy Humans Quality-adjusted Life Years Treatment Outcome Great Britain Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage.

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Use and effectiveness of prothrombin complex concentrates vs fresh frozen plasma in gastrointestinal hemorrhage due to warfarin usage in the ED.

Comparison of prothrombin complex concentrate and fresh frozen plasma on thrombin generation and hemorrhage in experimental dilutional coagulopathy

Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom.

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Modeling the cost-effectiveness of prothrombin complex concentrate compared with fresh frozen plasma in emergency warfarin reversal in the United kingdom.