PHD Candidate, Monash University Malaysia
Resources allocation on anticoagulation therapy for stroke prevention in patient with AF
For past decades, the only oral anticoagulant available to prevent stroke is warfarin, but it imposes lifestyle restrictions and the need for regular monitoring. However, with the development of science, we are now spoilt for choices with modern blood-thinning drugs known as novel oral anticoagulants (NOACs) that do not require monitoring, easy to live with but often at a considerable cost to the healthcare system, making them less accessible in lower income countries. Therefore, warfarin may continue to be widely utilized especially if efforts to improve the quality of current warfarin care are implemented. These efforts, known as bundled anticoagulant care may involve either the introduction of genotype-guided warfarin dosing, point-of-care testing or patient’s self-monitoring. As the therapeutic armamentarium for stroke prevention in atrial fibrillation has expanded, clinical-decision making in terms of anticoagulant choice has become more complex than ever. The absence of simultaneous clinical and economic comparison between these interventions further complicate matters. Therefore, my research aims to use decision-analysis model to compare the potential changes in both economic and clinical outcomes of using NOACs versus investing more resources to improve the quality of current warfarin care. Findings from this research can assist clinicians and administrators especially those from lower income countries with limited healthcare resources to be better informed on the decisions of resource allocation for anticoagulation therapy.