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Direct oral anticoagulants (DOAC) are more and more widely used in patients with atrial fibrillation. Unfortunately, the appropriateness of prescriptions is often incorrect resulting in increased risk of thromboembolic and hemorrhagic events. These events imply an important economic burden. In our institution, a clinical pharmacist is dedicated to revising the adequate use of the DOAC.Main objective of our analysis is to determine the economic impact of pharmaceutical interventions on the DOAC prescription by calculating the net cost avoidance thanks to pharmaceutical interventions.We included the medical hospitalized patients with DOAC prescribed. The appropriateness of the prescription was assessed using the "Medication Appropriateness’ Index" tool. The theoretical thromboembolic and hemorrhagic risks of patients under DOAC were collected from the literature. The potential individual risk of each patient is based on a probability of risk assignment conducted by two clinical pharmacists. A decisional diagram was built to attribute risk to each patient. Different costs were included: institutional diseases costs of the complications, annualized ambulatory stroke costs and drugs costs, pharmacist’s costs. We did not add a consultancy fee for the pharmacist. Finally, we performed an univariate sensitivity analysis to evaluate the robustness of our results.75/91 patients met the inclusion criteria. 36 out of them (48%) had an inappropriate DOAC prescription. The net cost benefit analysis shows that, thanks to the clinical pharmacist intervention, 3 631€ have been saved for 75 patients. The univariate sensivity analysis enlightened still a net cost benefit even with the presence of 28% inappropriate prescriptions or a 45% reduction of the disease's costs.Besides the enhancement of the prescription's quality by the clinical pharmacist, this analysis shows an economic interest of the activity in the field of DOAC prescription. A complete economic analysis should be considered to demonstrate the economic interest of a clinical pharmacist.

Anticoagulants --- Drug Prescriptions

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