Key result
Compared to warfarin, direct oral anticoagulants reduced total direct medical costs by 5.2% to 10.9% over 5 years, primarily due to lower costs associated with treating hemorrhagic complications.
Why the study?
To evaluate the clinical-economical effectiveness of direct oral anticoagulants compared with warfarin in atrial fibrillation therapy.
Do direct oral anticoagulants reduce direct medical costs and improve adjusted life years compared to warfarin in patients with atrial fibrillation?
Do direct oral anticoagulants reduce direct medical costs and improve adjusted life years compared to warfarin in patients with atrial fibrillation?
Effect estimate: 10.3% reduction (dabigatran), 5.2% reduction (rivaroxaban), 10.9% reduction (apixaban)
Direct oral anticoagulants are more cost-effective than warfarin for stroke prevention in atrial fibrillation, reducing direct medical costs primarily by decreasing bleeding complications.
Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy. Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”. Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment. Conclusion . Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost.
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Malchikova et al. (2020) studied Atrial fibrillation (n=100). Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban) vs. Warfarin was evaluated on Total direct medical costs over 5 years (10.3% reduction (dabigatran), 5.2% reduction (rivaroxaban), 10.9% reduction (apixaban)). Compared to warfarin, direct oral anticoagulants reduced total direct medical costs by 5.2% to 10.9% over 5 years, primarily due to lower costs associated with treating hemorrhagic complications.
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