Gourzoulidis G, Delli E, Wammes K, Papageorgiou G, Kourlaba G. Value in Health. 2020;23:S496. https://doi.org/10.1016/j.jval.2020.08.544

Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a significant cause of strokes and other related complications. Treatment with novel oral anticoagulant agents (NOACs) can substantially reduce these complications. In Greece, there is a tendency to use the lower doses of NOACs in common clinical practice for the treatment of patients with AF. Hence the aim of present study was to compare the annual cost for the management of clinical events occurred in patients with non-valvular AF (NVAF) treated with low dose of NOACs in Greece.

Methods: An excel-based cost model with one-year time horizon was adapted to evaluate the cost and health outcomes associated with the use of dabigatran110mg instead of rivaroxaban15mg and apixaban2,5mg from the payer perspective. The NOACs-related clinical events complications data such as ischemic stroke/systemic embolism, hemorrhagic stroke, ischemic stroke, any bleeding, major bleeding and all-cause mortality were taken from published study. Directly reimbursed costs associated with clinical events management were obtained from published literature and adjusted for inflation to 2020 cost levels. Epidemiological data such as the number of patients with AF receiving low dose of dabigatran, rivaroxaban and apixaban in Greece were extracted by local IQVIA databases.

Results: The analysis indicate that, the use of low-dose dabigatran instead of low-dose apixaban could potentially prevent 5,363 clinical events complications, resulting in annual cost-savings of €15,251,666 for public payer. Moreover, the model estimated that, 2,643 clinical events complications could have been averted with the use of low-dose dabigatran instead of low-dose rivaroxaban, resulting in annual cost-savings of €5,632,804 for the public payer.

Conclusions: The present study suggests that the use of low-dose dabigatran instead of low-doses of rivaroxaban or apixaban in patients with NVAF who had not previously taken a DOAC in Greece, is associated with better health outcomes and lower costs.