Key result
Non-vitamin K oral anticoagulants resulted in total annual societal costs of US$ 2,006 to US$ 2,557 per patient compared with US$ 2,358 to US$ 2,636 for warfarin in Denmark.
Why the study?
Does broadening the economic perspective from drug-only costs to health care and societal costs alter the cost comparison between non-vitamin K oral anticoagulants and warfarin in patients with nonvalvular atrial fibrillation in Denmark?
Does broadening the economic perspective from drug-only costs to health care and societal costs alter the cost comparison between non-vitamin K oral anticoagulants and warfarin in patients with nonvalvular atrial fibrillation in Denmark?
Answers are grounded in this paper and cite their sources.
Evaluating oral anticoagulants from a broad health care or societal cost perspective—rather than a narrow drug-budget silo—shows that NOACs are cost-saving or cost-neutral compared with warfarin in Denmark due to avoided strokes, intracranial bleeds, and INR monitoring.
AIM: Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting. METHODS: In a cost analysis, the annual average total costs of five oral anticoagulants (warfarin and non-vitamin K oral anticoagulants [NOACs; dabigatran, rivaroxaban, apixaban, and edoxaban]) used in daily clinical practice in Denmark for the prevention of stroke in NVAF patients are analyzed. This is done in pairwise comparisons between warfarin and each NOAC based on five potential cost perspectives, from a "drug cost only" perspective up to a "societal" perspective. RESULTS: All comparisons of warfarin and NOACs show that the cost perspective based on all relevant costs, ie, total costs perspective, is essential for the choice of therapy. Focusing on the reimbursement costs of the drugs only, warfarin is the least costly option. However, with the aim of therapy to prevent strokes and limit bleedings, including the economic impact of this, all NOACs, except rivaroxaban, result in slightly lower health care costs compared with warfarin. The same picture was found applying the societal perspective. CONCLUSION: Many broad cost-effectiveness analyses of NOACs exist. However, in countries with budget focus in decision-making this information does not apply. The present study's case of oral anticoagulants has shown that decision-making should be based on health care or societal cost perspectives for optimal use of limited resources. Otherwise, the risk is that suboptimal decisions will be likely.
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Poulsen et al. (2017) studied Nonvalvular atrial fibrillation (NVAF). Non-vitamin K oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) vs. Warfarin (3 tablets/day of 7.5 mg) with regular INR monitoring was evaluated on Annual average total societal costs per patient. Non-vitamin K oral anticoagulants resulted in total annual societal costs of US$ 2,006 to US$ 2,557 per patient compared with US$ 2,358 to US$ 2,636 for warfarin in Denmark.
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