Cost-effectiveness of using prothrombin complex concentrate to prevent complications related to overdoses of anticoagulants in the emergency department

Quintana Díaz M, Borobia AM, Pérez Cachafeiro S, Rodríguez C, García Erce JA

Background and objective: Prothrombin complex concentrates (PCCs) are currently

used principally for rapid reduction of the anticoagulant effects of administering

vitamin K in cases where acute bleeding develops or during emergency surgery. PCCs

are a better choice than fresh frozen plasma in these situations. These drugs have

become essential for reducing the risk of hemorrhage thanks to their composition,

safety, and rapid restoration of hemostasis, specifically of the international normalized

ratio (INR). This study aimed to assess the efficacy, in terms of incremental costeffectiveness,

of PCC use in restoring the INR in routine emergency department

practice.

Study design: For the cost-effectiveness analysis we constructed a year-by-year decisiontree

(Markov model) using spreadsheet software (Excel). The probabilistic simulation

sampled 5% of all emergency department patients on oral anticoagulant therapy with

antivitamin K and an elevated INR in each year for 10 years. Octaplex® was the PCC

used in the model.

Results: Sensitivity analysis showed that PCC use had a more favorable incremental costeffectiveness

ratio than did other strategies for correcting the INR.

Conclusions: Use of PCCs in the emergency department would be cost-effective.

Borobia AM, García Erce JA, Pérez Cachafeiro S, Quintana Díaz M, Rodríguez C