Assessing the Impact of Technology-Powered, Pharmacy- and Nursing-Supported Direct Oral Anticoagulant Management
Author(s)
Surbhi Shah, M.B.B.S.1, Evan Draper, Pharm. D.2, Che Ngufor, PhD3, Jim Moriarty, M.S.4, Todd Huschka, M.S.4, Mindy Mickelson, M.A.4, Bijan J. Borah, MSc, PhD5.
1Department of Hematologic and Medical Oncology, Mayo Clinic College of Medicine and Science, Pheonix, AZ, USA, 2Mayo Clinic College of Medicine and Science, Rochester, MN, USA, 3Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA, 4Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA, 5Professor of Health Services Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
1Department of Hematologic and Medical Oncology, Mayo Clinic College of Medicine and Science, Pheonix, AZ, USA, 2Mayo Clinic College of Medicine and Science, Rochester, MN, USA, 3Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA, 4Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA, 5Professor of Health Services Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
OBJECTIVES: Direct oral anticoagulants (DOACs) can lead to adverse events, particularly in patients with complex comorbid conditions. This study aimed to evaluate the clinical and financial impact of a technology-supported DOAC management intervention involving both pharmacy-led oversight and nursing support at a large U.S. health system site.
METHODS: This prospective observational study was conducted between 07/2023 and 06/2024. The multidisciplinary intervention team included care providers and/or pharmacists, nurse educators, and an IT team that facilitated clinical decision support tools. Study eligibility included age>=18, receipt of primary care at the health system site, being newly prescribed a DOAC, and enrollment in the study <=2 weeks of the initial DOAC prescription. Patients undergoing the intervention (n=414) were compared to standard-of-care (control) patients (n=5,831) using 1:4 propensity matching. We assessed following 30-day, 90-day, and 180-day outcomes: bleeding, thrombotic events, hospital admissions, length-of-stay (LOS), and healthcare costs. Appropriate multivariate regressions (logistic, Cox, generalized linear modeling) were used to adjust for any residual imbalance following propensity matching.
RESULTS: The final study sample included 2,070 patients (Intervention=414; Control=1,656). The average patient age was 73, with approximately 47% female patients in each arm of the matched cohort. Compared to the control group, the intervention group experienced significantly fewer thrombotic events at all time points (30-day: 1.9% vs. 3.9%; 90-day: 2.9% vs. 5.7%; 180-day: 4.3% vs. 7.8%; all p<=0.05). The 90-day admission rate (10.4% vs. 14.6%; p=0.028) and LOS (0.4 vs. 0.9 days; p=0.022) were also lower. The 30-day, 90-day and 180-day mean cost savings per patient were $3,302, $4,670, and $7,000, all statistically significant, representing 47%, 31%, and 27% savings, respectively.
CONCLUSIONS: The DOAC management intervention led to improved clinical outcomes and significantly reduced healthcare utilization, resulting in substantial cost savings. Similar interventions should be tested in other healthcare organizations to ensure the generalizability of these findings.
METHODS: This prospective observational study was conducted between 07/2023 and 06/2024. The multidisciplinary intervention team included care providers and/or pharmacists, nurse educators, and an IT team that facilitated clinical decision support tools. Study eligibility included age>=18, receipt of primary care at the health system site, being newly prescribed a DOAC, and enrollment in the study <=2 weeks of the initial DOAC prescription. Patients undergoing the intervention (n=414) were compared to standard-of-care (control) patients (n=5,831) using 1:4 propensity matching. We assessed following 30-day, 90-day, and 180-day outcomes: bleeding, thrombotic events, hospital admissions, length-of-stay (LOS), and healthcare costs. Appropriate multivariate regressions (logistic, Cox, generalized linear modeling) were used to adjust for any residual imbalance following propensity matching.
RESULTS: The final study sample included 2,070 patients (Intervention=414; Control=1,656). The average patient age was 73, with approximately 47% female patients in each arm of the matched cohort. Compared to the control group, the intervention group experienced significantly fewer thrombotic events at all time points (30-day: 1.9% vs. 3.9%; 90-day: 2.9% vs. 5.7%; 180-day: 4.3% vs. 7.8%; all p<=0.05). The 90-day admission rate (10.4% vs. 14.6%; p=0.028) and LOS (0.4 vs. 0.9 days; p=0.022) were also lower. The 30-day, 90-day and 180-day mean cost savings per patient were $3,302, $4,670, and $7,000, all statistically significant, representing 47%, 31%, and 27% savings, respectively.
CONCLUSIONS: The DOAC management intervention led to improved clinical outcomes and significantly reduced healthcare utilization, resulting in substantial cost savings. Similar interventions should be tested in other healthcare organizations to ensure the generalizability of these findings.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD9
Topic
Clinical Outcomes, Economic Evaluation, Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Oncology