Population cost analysis of direct oral anticoagulants versus vitamin K antagonists for managing nonvalvular atrial fibrillation

Abstract

Introduction: Oral anticoagulants are the treatment of choice for the prevention of cardioembolic events in nonvalvular atrial fibrillation (NVAF) and make up a significant proportion of pharmaceutical expenditure. The direct health care cost of anticoagulant treatment for NVAF was analysed at the population level using real-life data from Catalonia to compare vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (DOACs). Methods: Cost analysis using a population database comparing VKAs and DOACs over a period of 1 year from the perspective of the health system. The costs of treatment, follow-up, and hospitalization were analysed. Propensity score matching was performed to analyse the cost difference between the two groups. Costs were capitalized up to the year 2023 using discount rates of 5.6% and 8.9%. Results: In 2017 in Catalonia, there were 82,034 patients with NVAF on anticoagulant therapy, 64,732 (79%) with VKAs and 17,302 (21%) with DOACs. From the perspective of the national health care system, the cost/patient/year was €2,447.89 with VKAs vs. €2,809.53 with DOACs. After matching, the cost/patient/year was €2,767.65 with VKAs vs. €2,827.12 with DOACs (a difference of €59.47/patient/year). Conclusions: There is little cost difference between VKAs and DOACs. VKAs had higher costs of follow-up and hospitalization, while DOACs had a higher pharmacy cost. JEL CLASSIFICATION I. Health, Education, and Welfare: I19.