New oral anticoagulants for stroke prevention in atrial fibrillation: An update for managed care and hospital decision-makers

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a potent risk factor for stroke. AF-related stroke represents a significant economic burden, with an estimated $8 billion In direct annual costs. The new oral anticoagulants have several advantages over vitamin K antagonists (VKAs), including a predictable anticoagulation effect that allows for fixed dosing without routine laboratory monitoring, rapid onset and offset of action, and few drug and food interactions. Although acquisition and laboratory monitoring costs of VKAs are low, the time spent by clinicians managing bleeding events and drug interactions, as well as providing patient education, represents a considerable economic burden. Managed care and hospital decision-makers play an integral role in the clinical adoption of new therapeutic modalities, such as new anticoagulant agents, by making multidisciplinary, evidence-based decisions with the goal of improving quality of care while reducing healthcare costs. (Formulary. 2012;47:299-305.)