Cost-effectiveness analysis of warfarin and direct oral anticoagulants for the treatment of venous thromboembolism in Ramathibodi hospital
DOI:
https://doi.org/10.69898/jhtm.35.2025.279087Keywords:
Direct oral anticoagulants, Warfarin, Venous thromboembolism, Economic evaluationAbstract
Background: Direct oral anticoagulants (DOACs) are increasingly used, as they are non-inferior to warfarin in treating venous thromboembolism (VTE). However, the cost-effectiveness of DOACs relative to warfarin requires further investigation.
Objectives: The study aimed to evaluate the cost-effectiveness of DOACs versus warfarin in treating VTE from a societal perspective and to examine the rates of recurrent VTE and bleeding associated with anticoagulant treatment in the Thai population.
Materials and Methods: The study comprised a retrospective cohort from 2015 to 2019 and a prospective cohort from 2020 to 2021. Patients with newly diagnosed VTE who were treated with warfarin or DOACs were included. Direct medical costs were retrieved from hospital billing databases, while indirect medical costs were surveyed through interviews. The incremental cost-effectiveness ratio (ICER) for case avoided was calculated from a societal perspective.
Results: A total of 135 patients were included, with 87 (64.4%) receiving warfarin and 48 (35.5%) receiving DOACs. Bleeding events occurred in 15 (17%) of the warfarin-treated patients and 4 (8%) of the DOAC-treated patients, with major bleeding in 1 (1%) warfarin patients and none among DOAC patients. Recurrent VTE occurred in 5 (5.7%) warfarin patients and 4 (8.3%) DOAC patients. No significant difference in bleeding or recurrent VTE was observed between the warfarin and DOAC groups. The decision tree model showed the ICER of 11,181.63 USD per bleeding case avoided.
Conclusion: There were no significant differences in recurrence or bleeding rates between VTE patients receiving warfarin and those receiving DOACs. However, at its current price, DOACs appear to be less cost-effective than warfarin in prevent bleeding complications in the Thai population. A reduction in cost may improve their overall value and support broader adoption in clinical practice.
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