OBJECTIVES : This study aims to investigate the cost analysis of current warfarin peri-procedural management. Moreover, it looks at the cost-effectiveness of bridging compared with non-bridging of warfarin among patients who are subjected to peri-procedural warfarin management.

METHODS : A decision-analytic model including a one-year follow-up was used to analyze (i) the cost of warfarin peri-procedural management, (ii) the cost of bridging versus non-bridging. The outcome measures were the average cost-effectiveness ratio (ACER) of survival without events and were the incremental cost-effectiveness ratio (ICER) of two practical scenarios. The costs included in the study were sourced from HMC and the real cost of medical concomitant conditions was calculated. The model was based on Monte Carlo simulation. One-way and multivariant sensitivity analyses were performed to check the robustness of the results.

RESULTS : The total cost of thromboembolism was more significant than the total cost of hemorrhage. The main contributor to management expenditure is out-patient visit cost. The average cost of one case of survival without event during warfarin interruption is US$ 3,815 (QAR 13,889). Warfarin bridging slightly cost-effective than non-bridging. The management expense of warfarin bridging and non-bridging was (US$ 2,037 (QAR 7,415) and US$ 1,945 (QAR 7,080), respectively). The cost of management of severe ischemic stroke represented the highest cost per clinical event US$ 57,006 (QAR 207,502). The most powerful factor in the model output is the probability of thromboembolism.

CONCLUSIONS : The analysis revealed that the current practice of high warfarin bridging and low non-bridging is cost-effective versus low bridging and high non-bridging.