Letter to the Editor
Reply to the comment on “Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting”
Resposta ao comentário a «Estudo de custo-efetividade de rivaroxabano para prevenção de acidente vascular cerebral em doentes com fibrilhação auricular em Portugal»
João Morais
Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal
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setting”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "707" "paginaFinal" => "708" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "João Morais" "autores" => array:1 [ 0 => array:3 [ "nombre" => "João" "apellidos" => "Morais" "email" => array:1 [ 0 => "jaraujomorais@mail.telepac.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta ao comentário a «Estudo de custo-efetividade de rivaroxabano para prevenção de acidente vascular cerebral em doentes com fibrilhação auricular em Portugal»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In response to the comment by Dr. Luis Silva Miguel on the article “Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting”,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> of which I was the lead author, I would like to present the following clarifications on behalf of the authors.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial costs assigned to monitoring patients under warfarin</span><p id="par0010" class="elsevierStylePara elsevierViewall">On page 539 of the issue there is a brief explanation of how monitoring of patients under warfarin was costed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An expert panel with proven clinical experience was consulted to identify and quantify the resources used for monitoring patients under warfarin. The panel consisted of seven experts selected on the basis of geographic location, specialty, and number of patients treated as a percentage of the national total. The Delbecq method was adopted as providing more robust estimates.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The costs of monitoring patients under warfarin presented in the article refer to 2011 and were rounded up. An inflation rate of 3% per year was applied to all costs taken from sources prior to 2011. The resources identified for monitoring warfarin included INR measurement and medical consultations to adjust dosage on the assumption that the patient would not be present for 50% of such consultations. According to the expert panel, 35% of patients were managed in a primary care setting and 65% in a specialist setting (50% by internal medicine specialists and 50% by cardiologists).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The source of data on costs of patients followed in primary care was the table of state-funded health services published by the Central Administration of the Portuguese national health system (ACSS) on October 6, 2011. The costs of services paid directly by patients were not included in the analysis, since a large proportion of this population are exempt. The source of the costs of primary care consultations (without the patient present), and the costs incurred by patients managed by specialists, was Order in Council 132/2009, modified by Order in Council 839-A/2009. The costs of specialist consultations were based on the Cost Accounting Report of National Health Service hospitals for 2006, using the total unit cost. The costs for monitoring patients under warfarin are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Error in Table 4</span><p id="par0030" class="elsevierStylePara elsevierViewall">There is indeed an error in Table 4 in our article: the costs of the individual components (drug acquisition, drug monitoring and event treatment) are incorrect. The total costs and incremental cost-effectiveness ratios are correct. The corrected costs are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">On behalf of the authors, I appreciate the interest taken in our article and the comments made. It is not common practice for experts and specialists to engage in debate in the <span class="elsevierStyleItalic">Journal</span> using this important form of communication, but I am sure that it helps raise the profile of the <span class="elsevierStyleItalic">Journal</span>, of the subject-matter it publishes, and hence of its authors.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial costs assigned to monitoring patients under warfarin" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Error in Table 4" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morais J. Resposta ao comentário a «Estudo de custo-efetividade de rivaroxabano para prevenção de acidente vascular cerebral em doentes com fibrilhação auricular em Portugal». Rev Port Cardiol. 2015;34:707–708.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Monitoring patients under warfarin</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">1st monitoring</td><td class="td" title="table-entry " align="char" valign="top">€148.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="middle">Subsequent monitoring</td><td class="td" title="table-entry " align="left" valign="top">Primary care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specialist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€89.98 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1372139.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Financial costs for monitoring patients under warfarin.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Costs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rivaroxaban \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Warfarin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Difference \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€6142 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€6061 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug acquisition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€3280 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€3166 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug administration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€697 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€3533 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−€2835 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Event treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€2165 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">€2414 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−€249 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1372140.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cost-effectiveness results of base-case analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Morais" 1 => "C. Aguiar" 2 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 28 | 30 | 58 |
| 2024 September | 26 | 25 | 51 |
| 2024 August | 32 | 26 | 58 |
| 2024 July | 21 | 34 | 55 |
| 2024 June | 25 | 21 | 46 |
| 2024 May | 33 | 17 | 50 |
| 2024 April | 21 | 24 | 45 |
| 2024 March | 26 | 23 | 49 |
| 2024 February | 27 | 33 | 60 |
| 2024 January | 25 | 29 | 54 |
| 2023 December | 21 | 31 | 52 |
| 2023 November | 23 | 17 | 40 |
| 2023 October | 27 | 16 | 43 |
| 2023 September | 21 | 17 | 38 |
| 2023 August | 19 | 17 | 36 |
| 2023 July | 22 | 20 | 42 |
| 2023 June | 22 | 9 | 31 |
| 2023 May | 22 | 18 | 40 |
| 2023 April | 10 | 5 | 15 |
| 2023 March | 18 | 18 | 36 |
| 2023 February | 16 | 32 | 48 |
| 2023 January | 16 | 22 | 38 |
| 2022 December | 21 | 32 | 53 |
| 2022 November | 26 | 24 | 50 |
| 2022 October | 22 | 21 | 43 |
| 2022 September | 14 | 27 | 41 |
| 2022 August | 14 | 25 | 39 |
| 2022 July | 23 | 35 | 58 |
| 2022 June | 13 | 26 | 39 |
| 2022 May | 18 | 26 | 44 |
| 2022 April | 20 | 31 | 51 |
| 2022 March | 22 | 35 | 57 |
| 2022 February | 17 | 15 | 32 |
| 2022 January | 13 | 16 | 29 |
| 2021 December | 11 | 27 | 38 |
| 2021 November | 27 | 32 | 59 |
| 2021 October | 22 | 30 | 52 |
| 2021 September | 17 | 22 | 39 |
| 2021 August | 21 | 29 | 50 |
| 2021 July | 24 | 22 | 46 |
| 2021 June | 11 | 17 | 28 |
| 2021 May | 30 | 29 | 59 |
| 2021 April | 47 | 12 | 59 |
| 2021 March | 37 | 12 | 49 |
| 2021 February | 35 | 17 | 52 |
| 2021 January | 32 | 7 | 39 |
| 2020 December | 22 | 8 | 30 |
| 2020 November | 21 | 13 | 34 |
| 2020 October | 16 | 9 | 25 |
| 2020 September | 49 | 8 | 57 |
| 2020 August | 25 | 9 | 34 |
| 2020 July | 38 | 9 | 47 |
| 2020 June | 29 | 8 | 37 |
| 2020 May | 35 | 0 | 35 |
| 2020 April | 27 | 18 | 45 |
| 2020 March | 26 | 7 | 33 |
| 2020 February | 31 | 32 | 63 |
| 2020 January | 15 | 4 | 19 |
| 2019 December | 26 | 6 | 32 |
| 2019 November | 29 | 4 | 33 |
| 2019 October | 10 | 7 | 17 |
| 2019 September | 25 | 5 | 30 |
| 2019 August | 20 | 5 | 25 |
| 2019 July | 31 | 11 | 42 |
| 2019 June | 22 | 4 | 26 |
| 2019 May | 27 | 13 | 40 |
| 2019 April | 10 | 11 | 21 |
| 2019 March | 57 | 10 | 67 |
| 2019 February | 81 | 8 | 89 |
| 2019 January | 42 | 4 | 46 |
| 2018 December | 31 | 6 | 37 |
| 2018 November | 28 | 8 | 36 |
| 2018 October | 56 | 16 | 72 |
| 2018 September | 33 | 10 | 43 |
| 2018 August | 30 | 6 | 36 |
| 2018 July | 23 | 3 | 26 |
| 2018 June | 21 | 4 | 25 |
| 2018 May | 32 | 3 | 35 |
| 2018 April | 36 | 2 | 38 |
| 2018 March | 55 | 6 | 61 |
| 2018 February | 34 | 6 | 40 |
| 2018 January | 33 | 1 | 34 |
| 2017 December | 47 | 6 | 53 |
| 2017 November | 34 | 9 | 43 |
| 2017 October | 28 | 6 | 34 |
| 2017 September | 32 | 10 | 42 |
| 2017 August | 35 | 13 | 48 |
| 2017 July | 27 | 7 | 34 |
| 2017 June | 29 | 5 | 34 |
| 2017 May | 25 | 11 | 36 |
| 2017 April | 21 | 7 | 28 |
| 2017 March | 18 | 25 | 43 |
| 2017 February | 16 | 3 | 19 |
| 2017 January | 26 | 4 | 30 |
| 2016 December | 27 | 11 | 38 |
| 2016 November | 19 | 3 | 22 |
| 2016 October | 26 | 10 | 36 |
| 2016 September | 16 | 5 | 21 |
| 2016 August | 7 | 1 | 8 |
| 2016 July | 13 | 2 | 15 |
| 2016 June | 10 | 2 | 12 |
| 2016 May | 14 | 5 | 19 |
| 2016 April | 16 | 1 | 17 |
| 2016 March | 17 | 13 | 30 |
| 2016 February | 35 | 24 | 59 |
| 2016 January | 36 | 26 | 62 |
| 2015 December | 12 | 6 | 18 |
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