Abstract
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is present in around 1-2 % of the European population. In Norway the estimated prevalence is 65-82 000, and it is expected to double by 2060. People with AF have a fivefold risk of stroke and a threefold incidence of congestive heart failure in addition to doubled all-cause mortality. This thesis is a study of the introduction of new pharmaceuticals for anticoagulation use in Norway, with particular emphasis on their effect on the frequency of general practitioner (GP) visits for individuals with AF. Aim: Non-Vitamin K antagonist oral anticoagulants (NOACs) have been reimbursed in Norway since 2013, where one of their main benefits over warfarin was foreseen to be a reduction in visits to general practitioners. In this study I attempt to answer the research question; What s the reduction in GP visits when switching from warfarin to one of the NOACs, and what are the effects when using these estimates in a cost-effectiveness framework? Methods: Data was gathered from KUHR (Kontroll og Utbetaling av Helse Refusjoner) and NorPD (Norwegian Prescription Database) in order to conduct statistical analysis of GP visits associated with anticoagulation use. The change in the number of GP visits per year was estimated using a first difference approach. A Markov model was developed to assess the impact of the analysis in a cost-effectiveness framework. Results: Both GP visits and INR testing varied with the change in warfarin and NOAC users. The results from this study indicate that the reduction in GP visits per year when switching from warfarin to a NOAC ranges between 7 and 14, with an average of 10. The estimated reduction in GP costs per patient ranges from 38 100 to 76 700 NOK. Conclusion: One of the main arguments for using NOACs has been that patients will need fewer visits to the GP. This study finds that a switch from warfarin to NOACs do reduce the number of GP visits per year by 7 to 14, with an average of 10.