An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa
BACKGROUND. Warfarin is a commonly prescribed drug that needs to be monitored regularly. OBJECTIVES. To evaluate the quality of care of patients on warfarin and to determine the cost-effectiveness of this drug in a South African district hospital setting. METHODS. Quality of care was assessed through a structured patient interview, and cost-effectiveness of warfarin was determined by retrospective review of all costs over a 6-month period. RESULTS. A total of 110 participants from the dedicated warfarin clinic at Wentworth Hospital, Durban, were enrolled over a 1 -month period. The median cost of all warfarin-related expenditure was ZAR295.05 per patient per month (pppm) (interquartile range (IQR) 283.42 -333.17), with a mean (standard error of the mean (SEM)) cost of ZAR394.90 (53.03). The median cost for patients with non-valvular atrial fibrillation was ZAR294.40 pppm (IQR 283.85 - 345.10) and the mean (SEM) cost was ZAR430.54 (116.14), compared with an estimated cost of ZAR545.96 and ZAR673.85 per month for rivaroxaban and dabigatran tablets, respectively. Of the participants interviewed (N=110), 69.1% agreed or strongly agreed that monthly international normalised ratio monitoring frustrated them, 74.5% agreed or strongly agreed that they sometimes wished that they did not have to take warfarin, and 84.5% would be willing to pay for a drug that required less frequent blood tests and clinic visits. CONCLUSIONS. Warfarin still appears to be the most cost-effective drug in our setting, but it significantly affects patients' quality of life. We suggest a prospective head-to-head trial to compare both cost-effectiveness and quality of life of patients on warfarin and the new oral anticoagulants at a district hospital facility.
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South African Medical Association
2018
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oai:scielo:S0256-957420180013000162019-01-22An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South AfricaLaäs,D JNaidoo,MBACKGROUND. Warfarin is a commonly prescribed drug that needs to be monitored regularly. OBJECTIVES. To evaluate the quality of care of patients on warfarin and to determine the cost-effectiveness of this drug in a South African district hospital setting. METHODS. Quality of care was assessed through a structured patient interview, and cost-effectiveness of warfarin was determined by retrospective review of all costs over a 6-month period. RESULTS. A total of 110 participants from the dedicated warfarin clinic at Wentworth Hospital, Durban, were enrolled over a 1 -month period. The median cost of all warfarin-related expenditure was ZAR295.05 per patient per month (pppm) (interquartile range (IQR) 283.42 -333.17), with a mean (standard error of the mean (SEM)) cost of ZAR394.90 (53.03). The median cost for patients with non-valvular atrial fibrillation was ZAR294.40 pppm (IQR 283.85 - 345.10) and the mean (SEM) cost was ZAR430.54 (116.14), compared with an estimated cost of ZAR545.96 and ZAR673.85 per month for rivaroxaban and dabigatran tablets, respectively. Of the participants interviewed (N=110), 69.1% agreed or strongly agreed that monthly international normalised ratio monitoring frustrated them, 74.5% agreed or strongly agreed that they sometimes wished that they did not have to take warfarin, and 84.5% would be willing to pay for a drug that required less frequent blood tests and clinic visits. CONCLUSIONS. Warfarin still appears to be the most cost-effective drug in our setting, but it significantly affects patients' quality of life. We suggest a prospective head-to-head trial to compare both cost-effectiveness and quality of life of patients on warfarin and the new oral anticoagulants at a district hospital facility.South African Medical AssociationSAMJ: South African Medical Journal v.108 n.12 20182018-12-01journal articletext/htmlhttp://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742018001300016en |
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Laäs,D J Naidoo,M |
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Laäs,D J Naidoo,M An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
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Laäs,D J Naidoo,M |
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Laäs,D J |
title |
An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
title_short |
An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
title_full |
An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
title_fullStr |
An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
title_full_unstemmed |
An evaluation of warfarin use at an urban district-level hospital in KwaZulu-Natal Province, South Africa |
title_sort |
evaluation of warfarin use at an urban district-level hospital in kwazulu-natal province, south africa |
description |
BACKGROUND. Warfarin is a commonly prescribed drug that needs to be monitored regularly. OBJECTIVES. To evaluate the quality of care of patients on warfarin and to determine the cost-effectiveness of this drug in a South African district hospital setting. METHODS. Quality of care was assessed through a structured patient interview, and cost-effectiveness of warfarin was determined by retrospective review of all costs over a 6-month period. RESULTS. A total of 110 participants from the dedicated warfarin clinic at Wentworth Hospital, Durban, were enrolled over a 1 -month period. The median cost of all warfarin-related expenditure was ZAR295.05 per patient per month (pppm) (interquartile range (IQR) 283.42 -333.17), with a mean (standard error of the mean (SEM)) cost of ZAR394.90 (53.03). The median cost for patients with non-valvular atrial fibrillation was ZAR294.40 pppm (IQR 283.85 - 345.10) and the mean (SEM) cost was ZAR430.54 (116.14), compared with an estimated cost of ZAR545.96 and ZAR673.85 per month for rivaroxaban and dabigatran tablets, respectively. Of the participants interviewed (N=110), 69.1% agreed or strongly agreed that monthly international normalised ratio monitoring frustrated them, 74.5% agreed or strongly agreed that they sometimes wished that they did not have to take warfarin, and 84.5% would be willing to pay for a drug that required less frequent blood tests and clinic visits. CONCLUSIONS. Warfarin still appears to be the most cost-effective drug in our setting, but it significantly affects patients' quality of life. We suggest a prospective head-to-head trial to compare both cost-effectiveness and quality of life of patients on warfarin and the new oral anticoagulants at a district hospital facility. |
publisher |
South African Medical Association |
publishDate |
2018 |
url |
http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742018001300016 |
work_keys_str_mv |
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1756005900025331712 |