Why the study?
Stroke incurs significant direct medical costs and direct oral anticoagulants (DOACs) are alternatives to warfarin, but the direct medical costs of stroke and cost-effectiveness of DOACs in Malaysia were undefined.
Are DOACs cost-effective compared to warfarin in patients with atrial fibrillation-related stroke?
Are DOACs cost-effective compared to warfarin in patients with atrial fibrillation-related stroke?
DOACs are a cost-effective alternative to warfarin for AF-related stroke in Malaysia, supporting their broader use despite potentially higher upfront drug costs.
Answers are grounded in this paper and cite their sources.
May support DOAC preference for cost reasons in Malaysian AF stroke; leaves open need for prospective economic trials.
Background: Stroke has significant direct medical costs, and direct oral anticoagulants (DOACs) are better alternatives to warfarin for stroke prevention in atrial fibrillation (AF). This study aimed to determine the direct medical costs of stroke, with emphasis on AF stroke and the cost-effectiveness of DOACs among stroke patients in a tertiary hospital in Malaysia. Methods: This study utilised in-patient data from the case mix unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 2011 and 2018. Direct medical costs of stroke were determined using a top-down costing approach and factors associated with costs were identified. Incremental cost effectiveness ratio (ICER) was calculated to compare the cost-effectiveness between DOACs and warfarin. Results: The direct medical cost of stroke was MYR 11,669,414.83 (n = 3689). AF-related stroke cases had higher median cost of MYR 2839.73 (IQR 2269.79–3101.52). Regression analysis showed that stroke type (AF versus non-AF stroke) (p = 0.013), stroke severity (p = 0.010) and discharge status (p < 0.001) significantly influenced stroke costs. DOACs were cost-effective compared to warfarin with an ICER of MYR 19.25. Conclusions: The direct medical cost of stroke is substantial, with AF-stroke having a higher median cost per stroke care. DOACs were cost effective in the treatment of AF-related stroke in UKMMC.
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Azahar et al. (2022) studied this question.
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