Key result
Direct-acting oral anticoagulants are superior to warfarin for stroke prevention in non-valvular AF, but warfarin remains the most cost-effective choice in the South African public sector.
Why the study?
Will the use of direct-acting oral anticoagulants (DOACs) be more cost-effective than warfarin for non-valvular atrial fibrillation (NVAF) in the public healthcare setting in South Africa?
Systematic Review
Will the use of direct-acting oral anticoagulants (DOACs) be more cost-effective than warfarin for non-valvular atrial fibrillation (NVAF) in the public healthcare setting in South Africa?
Although DOACs offer superior clinical outcomes and quality of life compared to warfarin in non-valvular atrial fibrillation, high costs restrict their use in the South African public healthcare sector, keeping warfarin as the mainstay therapy until generic DOACs become available.
Answers are grounded in this paper and cite their sources.
Warfarin remains first-line in South African public sector due to cost; confirms DOAC superiority while underscoring economic barriers to adoption.
This review evaluates the current literature on available oral anticoagulants and atrial fibrillation with specific relevance to the South African (SA) public healthcare sector, focusing on the pharmacology and monitoring of anticoagulants, current guidelines, initiation of treatment and risk stratification, effectiveness of treatment, cost-effectiveness and specific costing implications. The direct-acting oral anticoagulants (DOACs) are superior to warfarin, with dabigatran being the preferred treatment option in patients with non-valvular atrial fibrillation (NVAF). Warfarin is still the preferred anticoagulant in patients with renal failure and prosthetic heart valves and is still the most cost-effective anticoagulant in the SA public sector setting. There is a growing body of evidence that demonstrates the advantages of DOACs over warfarin in NVAF. Warfarin will remain the anticoagulant of choice until cheaper generic DOACs become available.
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Laäs et al. (2018) conducted a systematic review in Atrial fibrillation (specifically non-valvular atrial fibrillation). Direct-acting oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. Dose-adjusted warfarin was evaluated on Cost-effectiveness and clinical effectiveness (stroke prevention and bleeding risk) in the South African public healthcare setting. Direct-acting oral anticoagulants are superior to warfarin for stroke prevention in non-valvular AF, but warfarin remains the most cost-effective choice in the South African public sector.
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