Assessment of the Economic Impact of Warfarin Substitution with Rivaroxaban
DOI:
https://doi.org/10.30968/jhphs.2026.171.1311Abstract
Objective: To evaluate the economic impact of substituting warfarin with rivaroxaban in geriatric patients undergoing anticoagulation therapy. Methods: A retrospective study conducted at the Central Institute of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Micro-costing and macro-costing analyses were performed, considering direct costs related to the use of warfarin and rivaroxaban, including expenses for medications, INR tests, and medical interconsultations for dose adjustment. Results: The analysis included 21 patients, of whom 17 (81.0%) were considered eligible for substitution. The cost simulation indicated savings of approximately R$ 2,758.31 (R$ 162.25/patient) with the adoption of rivaroxaban, mainly due to the elimination of the need for INR tests and medical consultations for dose adjustment. Conclusion: Substituting warfarin with rivaroxaban can result in significant cost savings for the institution, in addition to providing clinical benefits to patients. However, the adoption of this strategy should be preceded by a careful assessment of contraindications to ensure treatment safety and effectiveness.
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References
1. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios Contínua: características gerais dos domicílios e dos moradores 2018. Rio de Janeiro: IBGE; 2018.
2. Yong JH, Thavorn K, Hoch JS, et al. Potential Cost-Effectiveness of Ambulatory Cardiac Rhythm Monitoring After Cryptogenic Stroke. Stroke. 2016;47(9):2380-2385. doi:10.1161/STROKEAHA.115.011979
3. Silvestre CC, Cerqueira-Santos S. Use of Warfarin in Oral Anticoagulation Therapy: Challenges and EmpoderACO Strategy for Promoting Patient Empowerment in Self-Care. Arq Bras Cardiol. 2023;120(6):e20230335. doi:10.36660/abc.20230335
4. Brunton L, Chabner B, Knollman B. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. New York: McGraw-Hill ; 2011.
5. Rang R, Ritter JM, Flower RJ, et al. Rang & Dale Farmacologia. Rio de Janeiro: Elsevier; 2015.
6. Ning W, Wang S, Tang H, et al. Effect of different oral anticoagulants on cognitive function in patients with atrial fibrillation: A Bayesian network meta-analysis. Medicine (Baltimore). 2024;103(17):e37750. doi:10.1097/MD.0000000000037750
7. Li Y, Wu S, Zhou J, et al. Efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation combined with chronic kidney disease: a systematic review and meta-analysis. Thromb J. 2024;22(1):40. doi: 10.1186/s12959-024-00608-5.
8. Milling TJ Jr, Middeldorp S, Xu L, et al. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation. 2023;147(13):1026-1038. doi:10.1161/CIRCULATIONAHA.121.057844
9. Connolly SJ, Crowther M, Eikelboom JW, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019;380(14):1326-1335. doi:10.1056/NEJMoa1814051
10. Diken AI, Yalçınkaya A, Hanedan MO, Erol ME, Ercen Diken Ö. Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis. Phlebology. 2018;33(1):53-59. doi:10.1177/0268355516688358
11. Novaes HMD, Soárez PC. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saude Publica. 2020;36(9):e00006820. doi:10.1590/0102-311X00006820
12. Ministério da Saúde. Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. Diretriz metodológica: estudos de microcusteio aplicados a avaliações econômicas em saúde. Brasília: Ministério da Saúde; 2021.
13. Ministério da Saúde. Diretrizes metodológicas: análise de impacto orçamentário: manual para o Sistema de Saúde do Brasil. Brasília: Ministério da Saúde; 2012.
14. Salcedo J, Hay JW, Lam J. Cost-effectiveness of rivaroxaban versus warfarin for treatment of nonvalvular atrial fibrillation in patients with worsening renal function. Int J Cardiol. 2019;282:53-58. doi:10.1016/j.ijcard.2018.11.087
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