PCV45 - Cost Effectiveness Of Direct Oral Anticoagulants (DOACS) Compared With Warfarin: A Literature Review

Abstract

Direct oral anticoagulants (DOACs), including apixaban, rivaroxaban, dabigatran, edoxaban, are alternative anticoagulant therapies to warfarin in United States (US) to prevent strokes or recurrent venous thromboembolisms (VTEs), due to their lower risk of bleeding. Since DOACs cost more than warfarin, the objective of this study was to examine the published literatures on the cost-effectiveness of DOACs compared to warfarin. A literature review was conducted in PubMed using keywords: “cost-effectiveness”, “warfarin”, “apixaban” or “rivaroxaban” or “dabigatran” or “edoxaban”. The inclusion criteria were articles (1) measured costs from US societal or US payer perspective; (2) used standard warfarin therapy as comparator; (3) with full text published in peer-reviewed journals. We excluded non-human studies and literature reviews from the final review. A total of 46 studies were identified, and 11 studies met the selection criteria. Most studies (8) accessed the anticoagulant indications for stroke prevention in nonvalvular atrial fibrillation (AF) patients, and 2 studies also included indication for systemic embolism prevention and 1 in VTE, respectively. Ten studies included patients 65 years old and above, while 1 included patients aged over 60. Dabigatran was the most commonly studied DOACs (dabigatran, 6; apixaban, 3; rivaroxaban, 3; edoxaban, 2). Only two studies included indirect costs, such as travel cost and loss of productivity, in addition to the direct medical costs. ICER of any DOAC to warfarin ranged from -$60,725 to $45,372 with a $50,000 willingness-to-pay(WTP) per QALY. All articles concluded DOACs are cost-effective alternatives to warfarin for the studied indications from either societal or US payer perspective. This literature review reveals DOACs are cost-effective alternatives to warfarin in stroke prevention for AF patients, and in secondary VTE prevention, even after adjusting indirect cost associated with therapy. The parameters were obtained from literatures, and future studies are warranted to better understand the cost-effectiveness in practice.