During device surgery, warfarin wins over heparin for cost-effectiveness

Continuing with warfarin may be significantly more cost-effective than switching to heparin during pacemaker or defibrillator surgery.

In an economic analysis of the results from BRUISE CONTROL (Bridge or Continue Coumadin for Device Surgery Randomized Control Trial), researchers found that lower costs and fewer bruises per patient made continuing on warfarin a strong choice. In the parent study, 681 patients with nonemergency device surgery were randomized to either continue warfarin or bridge during surgery with heparin. For the cost-effectiveness portion, senior author Andrew D. Krahn, MD, of the Gordon & Leslie Diamond Health Care Centre in Vancouver, British Columbia, and colleagues evaluated the data based on Canadian unit costs for 2012 through 2013.

They found that continuing warfarin therapy was more than nine times less costly than heparin bridging (U.S.: $173 vs. $1,620, CAN: $218 vs. $2,041, respectively). This was driven largely by medication and hospitalization costs. They also noted that there were four and a half times more clinically significant hematomas when heparin was used as a bridge than when continuing warfarin. Further, they noted increased hematoma costs per patient in the heparin bridging group.

Krahn et al called continued warfarin therapy dominant as well as less costly, writing there was little uncertainty in the results, with a cost savings of approximately $1,428 (CAD $1,800) per patient at high risk of thromboembolic events during device surgery.

The findings were published in the March 10 issue of the Journal of the American College of Cardiology.