Weighing up blood-thinners: Is warfarin always the best choice?

New study guides clinicians and policy makers on cost-effectiveness of anticoagulant drugs

2013-10-17

(Press-News.org) Patients who are responding below par to the anticoagulant drug warfarin have several options. They can undergo even more blood tests to monitor their response to the different dosages of this medication which is prescribed to prevent strokes, or they could start using one of the newer, yet more expensive, anticoagulants on the market. In the long run, says Joyce You of the Chinese University of Hong Kong in China, the latter option could actually be more cost-effective and improve a patient's quality of life. Her study¹ appears in the Journal of General Internal Medicine, published by Springer. It is the first of its kind to comprehensively consider all important factors to measure the relative value-for-money of various oral anticoagulants currently on offer to patients and doctors.

The effectiveness of warfarin is influenced by the intake of Vitamin K and the impact of other medication. Incorrect dosages can, for instance, lead to excessive bleeding. Therefore health professionals consistently need to do blood tests to monitor its effectiveness.

According to previous studies, new oral anticoagulants such as dabigatran, rivaroxaban and apixabanare are as effective as warfarin in preventing strokes, and similarly all can cause bleeding in patients if not used correctly. Warfarin, which has been on the market for decades, is still the No. 1 anticoagulant used in the US and the UK, while the newer drugs are considered to be more expensive. Because they have a shorter half-life than warfarin, they lose their pharmacological effectiveness much sooner, and also need to be taken more regularly than warfarin.

To provide a definitive word on which is the most cost-effective in the long run within the broader medical care system, You compared the life-long economic and treatment outcomes of warfarin against the new generation medications. She ran a randomized statistical outcome analysis of a hypothetical group of 65-year-old people suffering from atrial fibrillation (a heart rhythm disorder), and also included additional information from previous clinical trials.

Dr. You specifically measured if the price tag of a specific treatment was worthwhile and if it influenced a patient's general quality of life, in the sense that the person could undergo fewer cumbersome blood tests or monitoring sessions to ensure that the treatment adequately prevented strokes. Generally, warfarin treatment is regarded as successful if a patient is within the needed therapeutic range for 75 percent or more of the time. A percentage less than 60 percent is sub-optimal, and generally needs more monitoring and intervention from practitioners.

Dr. You found that, generally, the use of warfarin was most cost-effective when patients were within the successful therapeutic range for more than 70 percent of the time. She found, however, that in patients where this range dropped below 60 percent, the more expensive new drugs were more cost-effective in the long run. Clinicians have the option of intensifying the management of warfarin therapy (including more frequent blood tests and management by specialists) until a 70 percent therapeutic range is reached, but this has added financial implications.

"The acceptance of the new oral anticoagulants as a more cost-effective option than warfarin therapy is highly dependent on the level of anticoagulation control achieved by warfarin therapy, cost for anticoagulation service to manage patients on warfarin, and drug cost of the new oral anticoagulants," You concluded.

###

References:

1. You, H.S.J. (2013). Novel Oral Anticoagulants versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation – A Cost-Effectiveness Analysis, Journal of General Internal Medicine. DOI 10.1007/s11606-013-2639-2 2. The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine.

The full-text article is available to journalists on request.

ELSE PRESS RELEASES FROM THIS DATE:

Depression twice as likely in migraine sufferers

2013-10-17

TORONTO, ON — The prevalence of depression among those with migraine is approximately twice as high as for those without the disease (men: 8.4% vs. 3.4%; women 12.4% vs. 5.7%), according to a new study published by University of Toronto researchers. In a paper published online this week in the journal Depression Research and Treatment, investigators reported that younger migraine sufferers were particularly at risk for depression. Women with migraines who were younger than 30 had six times the odds of depression in comparison to sufferers who were aged 65 and over, said ...

A grand unified theory of exotic superconductivity?

2013-10-17

UPTON, NY -- Years of experiments on various types of high-temperature (high-Tc) superconductors—materials that offer hope for energy-saving applications such as zero-loss electrical power lines -- have turned up an amazing array of complex behaviors among the electrons that in some instances pair up to carry current with no resistance, and in others stop the flow of current in its tracks. The variety of these exotic electronic phenomena is a key reason it has been so hard to identify unifying concepts to explain why high-Tc superconductivity occurs in these promising materials. Now ...

Misconceptions about HPV vaccine explored in special issue of scientific journal

2013-10-17

INDIANAPOLIS -- Suspicions about sexual promiscuity and vaccine safety are explored in an article in the November issue of the journal Preventive Medicine, which dedicates a section of that issue to research concerning the human papillomavirus. "Beliefs, behaviors and HPV vaccine: Correcting the myths and the misinformation" is a review of journal articles and other medical and social science literature exploring beliefs held by the general public that have an impact on HPV vaccination acceptance. Human papillomavirus is the primary cause of cervical cancer, with 12,000 ...

Celmatix study shows women may be stopping IVF treatment prematurely

2013-10-17

Boston, MA – October 17, 2013 – Celmatix, a biotechnology company focused on helping physicians guide patients to treatments that maximize their personal reproductive potential, announced today six research presentations at the annual meeting of the American Society for Reproductive Medicine (ASRM), being held October 1217 in Boston. Among the data presented was a new study suggesting that up to 25 percent of patients may be discontinuing assisted reproductive therapies such as in vitro fertilization (IVF) early, while they still have a good chance of having a baby. The ...

Next-generation gene sequencing can identify invasive carp species in Chicago area waterways

2013-10-17

A project to map the microbes present in the digestive systems of fish species holds promise for monitoring the presence of Asian carp in Chicago area waterways and ultimately preventing their spread, according to a study published in Nature's ISME Journal. The work, funded through the U.S. Environmental Protection Agency Great Lakes Restoration Initiative, is being conducted by researchers from the University of Illinois at Urbana-Champaign and the U.S. Geological Survey (USGS). Asian carp is a term used to refer to several invasive fish species including silver, bighead ...

Yoga accessible for the blind with new Microsoft Kinect-based program

2013-10-17

In a typical yoga class, students watch an instructor to learn how to properly hold a position. But for people who are blind or can't see well, it can be frustrating to participate in these types of exercises. Now, a team of University of Washington computer scientists has created a software program that watches a user's movements and gives spoken feedback on what to change to accurately complete a yoga pose. "My hope for this technology is for people who are blind or low-vision to be able to try it out, and help give a basic understanding of yoga in a more comfortable ...

Nanotech system, cellular heating may improve treatment of ovarian cancer

2013-10-17

CORVALLIS, Ore. – The combination of heat, chemotherapeutic drugs and an innovative delivery system based on nanotechnology may significantly improve the treatment of ovarian cancer while reducing side effects from toxic drugs, researchers at Oregon State University report in a new study. The findings, so far done only in a laboratory setting, show that this one-two punch of mild hyperthermia and chemotherapy can kill 95 percent of ovarian cancer cells, and scientists say they expect to improve on those results in continued research. The work is important, they say, ...

Mathematical study of photosynthesis clears the path to developing new super-crops

2013-10-17

How some plant species evolved super-efficient photosynthesis had been a mystery. Now, scientists have identified what steps led to that change. Around three per cent of all plants use an advanced form of photosynthesis, which allows them to capture more carbon dioxide, use less water, and grow more rapidly. Overall this makes them over 50% more efficient than plants that use the less efficient form. A new study has traced back the evolutionary paths of all the plants that use advanced photosynthesis, including maize, sugar cane and millet, to find out how they evolved ...

Smartphones, GPS part of UH scientist's smoking cessation research

2013-10-17

We use them to text, tweet, post and, sometimes, make a call. Now, smartphones are helping with public health research. A recently published smoking cessation study conducted by a researcher affiliated with the University of Houston includes a technique called "geo-mapping," which makes use of GPS technology to pinpoint a study participant's location and the location of tobacco retail outlets nearby. The study was published in the journal Nicotine and Tobacco Research. "We're examining the possible mechanisms underlying the relationship between being close to ...

How subtle movements and facial features could predict your demise

2013-10-17

PRINCETON, NJ—Features like the wrinkles on your forehead and the way you move may reflect your overall health and risk of dying, according to recent health research. But do physicians consider such details when assessing patients' overall health and functioning? In a survey of approximately 1,200 Taiwanese participants, Princeton University researchers found that interviewers — who were not health professionals but were trained to administer the survey — provided health assessments that were related to a survey participant's risk of dying, in part because they were attuned ...

Weighing up blood-thinners: Is warfarin always the best choice?

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: