PLoS ONE (Jan 2023)

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.

  • 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

DOI
https://doi.org/10.1371/journal.pone.0283604
Journal volume & issue
Vol. 18, no. 4
p. e0283604

Abstract

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ObjectivesCurrently, 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.MethodsThis 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.ResultsDuring 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), pConclusionOur 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.