AbstractBackgroundNon‐vitamin K antagonist oral anticoagulants (NOACs) are effective alternatives to warfarin for stroke prevention in non‐valvular atrial fibrillation (NVAF) patients. However, concerns have arisen due to their higher costs than warfarin.AimTo estimate and compare the total direct medical costs of warfarin, dabigatran and rivaroxaban treatments in NVAF patients in Penang general hospital.MethodsThis was a retrospective study capturing one year of data from January to December 2015. The data were extracted from hospital records. The total direct medical costs, including any costs associated with treatment‐related complications, were calculated as the sum of drug acquisition cost, INR point‐of‐care testing cost, personnel cost and treatment‐related complications cost. Descriptive statistical analysis was performed to describe the results.ResultsA total of 224 patients (warfarin, n = 122; dabigatran, n = 63; rivaroxaban, n = 39) were recruited. The total direct medical costs including cost of any treatment‐related complications for warfarin ranged from MYR1269.77 to MYR2383.35. The total direct medical costs with treatment‐related complications for dabigatran and rivaroxaban were MYR3469.18 and MYR2883.35, respectively. During the study period, one ischaemic stroke (0.82%) and three major bleeding events (2.46%) were observed in the warfarin group, whereas only one patient (1.59%) in the dabigatran group experienced minor bleeding. Drug acquisition costs for NOACs were high, which accounted for 80% of the total direct medical costs in the dabigatran group. However, the direct medical costs for warfarin increased by 4‐fold when treatment‐related complications costs were included.ConclusionThe direct medical costs of NOACs were relatively higher than warfarin, however, the incidence of major bleeding was higher in the warfarin group.