Key result
DOACs account for ~98% of Spain's oral anticoagulant spending.
Why the study?
In Spain, poor control of vitamin K antagonists in non-valvular atrial fibrillation and current recommendations support prioritising direct oral anticoagulants, motivating an evaluation of the national transition from VKAs to DOACs, expenditure, and potential generic savings.
Observational
Spain has transitioned to a DOAC-dominated anticoagulation model where introducing generic factor Xa inhibitors with a 30% price reduction could save €194.4 million annually.
Spain's rising DOAC use may align with guidelines; leaves open real-world outcome and cost-effectiveness impacts.
Background Oral anticoagulation prevents cardioembolic stroke and venous thromboembolism. In Spain, poor control of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation and current recommendations support prioritising direct oral anticoagulants (DOACs). This study describes Spain’s transition from VKAs to DOACs and estimates expenditure and potential generic savings. Methods Ecological drug-utilisation study using national consumption data for acenocoumarol, warfarin, dabigatran, rivaroxaban, apixaban and edoxaban (ATC B01AA, B01AE07, B01AF01–03) from 2010 to 2024, expressed as DDD/1,000 inhabitants/day. Trends by substance and ATC group were analysed. For 2024, retail expenditure including VAT was described and a 30% price-reduction scenario for generic rivaroxaban, apixaban and edoxaban was modelled. Results Between 2010 and 2024, oral antithrombotic exposure almost tripled, from 6.62 to 18.22 DDD/1,000/day. VKAs remained around 6.5–7.0 until 2016 and then declined to 4.34 in 2024, mainly due to acenocoumarol, while warfarin stayed near 0.4–0.5. Dabigatran rose from 0.04 to 1.62 DDD/1,000/day and factor Xa inhibitors from near zero to 12.26, led by apixaban (5.51), rivaroxaban (3.48) and edoxaban (3.28). DOACs accounted for about 76% of oral anticoagulant exposure. In 2024, expenditure reached €793.2 million; VKAs represented €15.7 million (≈2%), while DOACs accounted for 98%. A 30% price reduction for generic rivaroxaban, apixaban and edoxaban would generate potential annual savings of €194.4 million, about 25% of current spending, without reducing exposure. Conclusions Spain has shifted to a DOAC-dominated anticoagulation model, although residual VKA use remains clinically relevant. Most spending is now concentrated in DOACs, so maintaining VKA use offers limited economic benefit while preserving avoidable risk. DOAC generics could create a major efficiency margin to improve NVAF detection, anticoagulation quality and equitable access. Key messages • Spain has shifted to a DOAC-dominated anticoagulation model, while residual VKA use remains clinically relevant. • DOAC generics could save €194.4 million annually in Spain, creating efficiency gains to improve detection, quality and equity.
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Ortells et al. (2026) conducted an observational in Cardioembolic stroke, venous thromboembolism, and non-valvular atrial fibrillation. Direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, apixaban, edoxaban) vs. Vitamin K antagonists (VKAs: acenocoumarol, warfarin) was evaluated on Oral anticoagulant consumption (DDD/1,000 inhabitants/day) and retail expenditure in 2024. DOACs accounted for 76% of Spain's oral anticoagulant exposure and 98% of the €793.2M expenditure in 2024, with 30% generic price reductions projected to save €194.4M annually.
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