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Observational Study
. 2023 Apr 4;18(4):e0283604.
doi: 10.1371/journal.pone.0283604. eCollection 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  1   2   3 , Matthieu Piccoli  2   3 , Bastien Genet  2   3 , Stéphane Bouee  4 , Stefan Berechet  5 , Ion Berechet  5 , Antonin Dacasa Cortes  6 , Sabri Atsamena  7 , Catherine Bayle  2   3   8 , Mihai Badescu  9 , François Catelain  10 , Lynda Kermeche  11 , Isabelle Merlier  12 , Sahondranirina Rakotoniary  13 , Valérie Savin  14 , Ariane Vidal  15 , Jean-Sébastien Vidal  2   3 , Olivier Hanon  2   3
Affiliations
Observational Study

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 et al. PLoS One. .

Erratum in

Abstract

Objectives: Currently, 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.

Methods: This 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.

Results: During 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), p<.0001) for general practitioner care (€297 (91) vs. €204 (91), p = 0.02), for coordinating physicians care (€13 (7) vs. €5 (7), p < 0.07), for laboratory tests (€23 (5) vs. €5 (5), p<.0001), but were lower for drug costs (€8 (3) vs. €165 (3), p<.0001). The average overall cost for 3 months per patient was €668 (140) with VKA vs. €533 (139) with DOAC (p = 0.02).

Conclusion: Our 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.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: S.Bou., G.P.D., S.Ber., I.B., B.G., A.D.C., S.A., C.B., M.B., F.C., L.K., I.M., S.R., V.S. and A.V. have no conflict of interest. J.S.V. received honoraria for lectures for non-profit medical association from Bayer for lectures. M.P. received personal fees from Bayer Healthcare. O.H. received personal fees from Bayer Healthcare, BMS, Pfizer, Boehringer Ingelheim, Servier, Astra-Zeneca, Boston Scientific, Vifor, Leo Pharma, Sanofi, Medtronic and Amgen. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Detailed and overall costs of DOAC and VKA treatments for 3 months.
VKA, vitamin K antagonists; DOAC, direct oral anticoagulants; GP, General practitioner; CP, coordinating physician.
See this image and copyright information in PMC

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