Building a case for the DAWN DOAC dashboard in your Anticoagulation Stewardship Program

The DAWN DOAC Dashboard saves significant time AND money, while improving patient outcomes and reducing adverse events.

DOAC reviews generally fall outside the remit of Anticoagulant Management Services. They are supposed to be completed in family doctors’ offices and elsewhere in the health system, but all too frequently, these reviews do not happen at all.

Furthermore, over two thirds of all DOAC prescription issues occur after the initial prescription is written, highlighting the need for continual review and intervention¹.

Bringing DOAC reviews into the remit of the Anticoagulation Service requires investment which must be justified by improved health outcomes, increased efficiencies and cost reductions.

1, Herron GC, DeCamillo D, Kong X, Haymart B, Kaatz S, Ellsworth S, Ali MA, Giuliano C, Froehlich JB, Barnes GD. Timing of Off-Label Dosing of Direct Oral Anticoagulants in Three Large Health Systems. Thromb Haemost. 2025 Mar;125(3):278-285. doi: 10.1055/a-2365-8681. Epub 2024 Jul 15. PMID: 39009007.

What is the DAWN DOAC Dashboard?

Making the case for the DAWN DOAC Dashboard in your service

The following examples can be used for building a case for the DAWN DOAC Dashboard in your service. They are based on a notional health system with 15,000 DOAC patients to demonstrate the potential effectiveness of the DAWN DOAC population management dashboard.

Safer, more effective and efficient DOAC use

Using conventional chart reviews, assuming 20 minutes per review, it is possible to review 24 charts in a day. It would take at least 625 days for an FTE to review 15,000 DOAC patients. While most of these prescriptions would be on-label with no action required it takes a huge amount of resource to identify those who need intervention. If only 10% of patients require an intervention, only 2 – 3 interventions are identified each day.

With the DAWN DOAC dashboard, a pharmacist or nurse only reviews the prescriptions flagged as off-label. The review time is shorter (say about 15 minutes) as the most important information is clearly displayed, allowing up to 32 reviews per day (33% more). If 60% of these patients need an intervention, 19 interventions could be managed, over 5 times more than by chart review.

Furthermore, a single FTE pharmacist or nurse could review all off-label alerts in 2 – 4 months.

In a 2024 meta-analysis study, patients under pharmacist-led interventions were over three times more likely to receive appropriate anticoagulant therapy.²

²Belayneh Kefale, Gregory M Peterson, Corinne Mirkazemi, Woldesellassie M Bezabhe, The effect of pharmacist-led interventions on the appropriateness and clinical outcomes of anticoagulant therapy: a systematic review and meta-analysis, European Heart Journal – Quality of Care and Clinical Outcomes, Volume 10, Issue 6, September 2024

Cost savings using the DAWN DOAC Dashboard

According to the U.S. Bureau of Labor Statistics, as of May 2023 the mean annual salary for a PharmD is circa $135,000 per annum. If we assume 250 working days, this gives a daily salary cost of $540.

Review Method	No of charts reviewed per day	DOAC interventions per day (based on 10% of patients having an off-label DOAC dose)	Cost per DOAC intervention (Salary / working days / interventions per day)	No of days to review patient population	Total cost (PharmD daily cost * no days to review population OR those patients flagged for review)
Conventional chart review process (20 minutes each – all patients)	24	2.4	$225.00	625	$337,500.00
IN THE CONVENTIONAL CHART REVIEW EXAMPLE ABOVE THE ENTIRE PATIENT POPULATION MUST BE REVIEWED INCREASING COSTS
DAWN DOAC Dashboard (15 minutes each – flagged patients only)	32	19	$28.00	79	$42,660.00
IN THE DAWN DOAC DASHBOARD EXAMPLE ABOVE ONLY PATIENTS FLAGGED WITH QUESTIONABLE PRESCRIBING NEED A REVIEW, DRASTICALLY DECREASING TIME AND COST

To review a 15,000 DOAC population using the DOAC Dashboard approach compared to manual chart reviews would save the health system c$300,000.00 (many more times the cost of the software providing an outstanding return on investment).

Meaning it is 8 times cheaper to identify and intervene on inappropriate DOAC prescription using the DAWN DOAC Dashboard approach.

Reduce adverse patient events for improved care and even more cost savings

Services taking a population management dashboard approach have reported a 0.5 per 100 patient years reduction in VTE and stroke events.

Again, using the notional 15,000 DOAC patient population, a conventional chart review process would expect to see 2.75 ^3,4,5 VTE events per 100 patient years or a total of 412.5 VTE events.

Using the DAWN DOAC Dashboard, across the patient population could see a reduction of 75 VTE or stroke events. With a $20,000 ⁶ cost to treat a VTE event, this reduction in events would equate to a saving in the region of $1.5 million. (Of course, the alleviation of trauma and suffering by the patient should also be a primary consideration.)

To be conservative, this calculation assumes all preventable events were VTE and not strokes. However, stroke treatment costs are six to seven times higher than VTE, making these savings estimates highly cautious.

Combined with the labour savings detailed above, a health system managing 15,000 DOAC patients could conservatively expect savings of $1.5 to $1.8 million.

Reduction in Stroke/VTE rate with Dashboard approach

A population-based approach to DOAC monitoring is proven to be more efficient and effective in identifying prescriptions that require intervention before they result in adverse drug events.

NB: Studies discuss improved outcomes due to population management tools in general and aren’t specific to the DAWN DOAC Dashboard.

The DAWN DOAC Dashboard identifies prescriptions requiring intervention much faster than conventional chart reviews.

³ Fang MC, Reynolds K, Fan D, et al. Clinical Outcomes of Direct Oral Anticoagulants vs Warfarin for Extended Treatment of Venous Thromboembolism. JAMA Netw Open. 2023;6(8):e2328033. doi:10.1001/jamanetworkopen.2023.28033

⁴Glise Sandblad K, Rosengren A, Schulman S, Roupe M, Sandström TZ, Philipson J, Svennerholm K, Tavoly M. Excess risk of bleeding in patients with venous thromboembolism on direct oral anticoagulants during initial and extended treatment versus population controls. J Intern Med. 2025 Apr;297(4):382-399. doi: 10.1111/joim.20067. Epub 2025 Feb 13. PMID: 39949028; PMCID: PMC11913760.

⁵Barnes GD, Chen C, Holleman R, Errickson J, Seagull FJ, Dorsch MP, Allen AL, Spoutz P, Sussman JB. Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort. J Am Heart Assoc. 2024 Sep 17;13(18):e035859. doi: 10.1161/JAHA.124.035859. Epub 2024 Sep 9. PMID: 39248259; PMCID: PMC11935639

⁶Grosse SD, Nelson RE, Nyarko KA, Richardson LC, Raskob GE. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thromb Res. 2016 Jan;137:3-10. doi: 10.1016/j.thromres.2015.11.033. Epub 2015 Nov 24. PMID: 26654719; PMCID: PMC4706477.

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