Bridging vs Non-Bridging with Warfarin Peri-Procedural Management: Cost and Cost-Effectiveness Analyses

• Published in: Current problems in cardiology 2021-11, Vol.46 (11), p.100839-100839, Article 100839
• Main Authors: Eljilany, Islam, Elewa, Hazem, Abdelsamad, Osama, Abdelgelil, Mohamed, Mahfouz, Ahmed, Anany, Rasha Al, Yafei, Sumaya Al, Al-Badriyeh, Daoud
• Format: Article
• Language: English
• ISSN: 0146-2806; 1535-6280
• DOI: 10.1016/j.cpcardiol.2021.100839

•There is considerable uncertainty regarding the potential therapeutic benefits of parenteral anticoagulant bridging vs the putative bleeding risks. Significant limitations undermine the benefit of bridging.•The mean overall cost of peri-procedural warfarin managment per patient was USD 3,260 (QAR 11,900) in Qatar.•The overall success rate (ie, survival with no adverse events) of peri-procedural warfarin management was 75.2%.•Bridging was dominant (ie, higher effect and lower cost) over the predominant non-bridging practice in 62.2% of simulated patient cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993), and was cost-effective in 36.9% of the cases.•The outpatient visit category of cost was the highest among admission and resource cost categories. The warfarin peri-procedural management in Qatar is predominantly based on bridging (63%), compared to non-bridging. This study sought to perform a first-time cost analysis of current warfarin peri-procedural management practices, including a cost-effectiveness analysis (CEA) of predominant bridging vs predominant non-bridging practices. From the hospital perspective, a one-year decision-analytic model followed the cost and success consequences of the peri-procedural warfarin in a hypothetical cohort of 10,000 atrial fibrillation patients. Success was defined as survival with no adverse events. Outcome measures were the cost and success consequences of the 63% bridging (vs not-bridging) practice in the study setting, ie, Hamad Medical Corporation, Qatar, and the incremental cost-effectiveness ratio (ICER, cost/success) of the warfarin therapy when predominantly bridging based vs when predominantly non-bridging based. The model was based on Monte Carlo simulation, and sensitivity analyses were performed to confirm the robustness of the study conclusions. As per 63% bridging practices, the mean overall cost of peri-procedural warfarin management per patient was USD 3,260 (QAR 11,900), associated with an overall success rate of 0.752. Based on the CEA, predominant bridging was dominant (lower cost, higher effect) over the predominant non-bridging practice in 62.2% of simulated cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993) and was cost-effective in 36.9% of cases. Being between cost-saving and cost-effective, compared to predominant non-bridging practices, the predominant use of bridging with warfarin seems to be a favorable strate