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International Journal of Clinical Pharmacy

, Volume 41, Issue 2, pp 546–554 | Cite as

Hospitalization period and direct medical cost in patients using warfarin or novel oral anti‐coagulants after a cerebral embolism

  • Tomohide AkaseEmail author
  • Takanori Tsuchiya
  • Masami Morita
Research Article

Abstract

Background Warfarin has been used in Japan for a long time in patients after cerebral embolism to prevent recurrence. Recently, several novel oral anti-coagulants (NOACs) have been approved for use and are gradually replacing warfarin. However, it remains unclear whether warfarin and other NOACs differ from each other with respect to drug costs and length of stay (LOS) during treatment in Japan. Objective To assess differences in LOS and direct medical cost between patients after cerebral embolism treated with warfarin and those treated with NOACs. Setting Thirteen acute care hospitals in Japan. Method For hospitalized patients with cerebral embolisms who were treated with NOACs and/or warfarin between April 2012 and March 2014, we assessed LOS for patients with warfarin and NOAC using log-rank test, and stratified proportional hazard regression. Also, we assess direct medical cost using paired-t test. Main Outcome measure LOS and medical cost after first treatment with warfarin and NOAC. Results The median LOS for NOACs-treated patients was 12.5 days and that for warfarin treated patients was 19.0 days while the corresponding mean medical costs were USD 7151 ± 6228 [JPY 736,546 ± 641,437] and USD 8950 ± 5891 [JPY 921,830 ± 606,765]. The drug cost for NOACs-treated patients was higher but costs for laboratory-test and hospitalization were lower than those for warfarin-treated patients. Conclusions For NOAC-treated patients, LOS was shorter, and medical cost during hospitalization tended to be lower than those for warfarin-treated patients, whereas NOACs prices were higher than warfarin price.

Keywords

DOAC Hospitalization period Japan Medical cost NOAC Novel oral anti-coagulants Warfarin 

Notes

Funding

This research was not supported by any external funding.

Conflicts of interest

Tomohide Akase has no conflicts of interest to declare. Masami Morita (M.M) was an employee at Shionogi & Co., Ltd at the time of performing this research. Takanori Tsuchiya (T.T) is an employee for Pfizer Japan Inc. However, the roles of M.M and T.T in these companies were not related to this research at the time of conducting the research.

Supplementary material

11096_2019_792_MOESM1_ESM.pptx (76 kb)
Supplementary material 1 (PPTX 75 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tomohide Akase
    • 1
    • 2
    Email author
  • Takanori Tsuchiya
    • 2
    • 3
  • Masami Morita
    • 2
    • 3
  1. 1.Graduate School of BusinessJapan University of EconomicsTokyoJapan
  2. 2.Pharmacy Management InstituteTokyoJapan
  3. 3.Office of Pharmaceutical Industry ResearchTokyoJapan

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