The affordability of adding a direct-acting oral anticoagulant to the national list of essential medicine for patients with non-valvular atrial fibrillation in Thailand: a budget impact analysis

ABSTRACT

Background

Atrial fibrillation (AF) can lead to a significant health and economic burden to society. This study aimed to assess the net budget impact of direct-acting oral anticoagulants (DOACs) instead of warfarin for stroke prevention in patients with non-valvular AF from the payer’s perspective.

Methods

A budget model over a 5-year period was used. Dabigatran 150 mg, dabigatran 110 mg, apixaban 5 mg, rivaroxaban 20 mg, edoxaban 60 mg, and edoxaban 30 mg were included. Inputs were retrieved from published literature. Adoption rate of DOACs started at 5% and subsequently had a 5% increase in each year. Net budget impact (NBI) and sensitivity analyses were performed.

Results

The average NBI over the 5-year horizon for all DOACs ranged from 12.3 M USD to 13.9 M USD. Dabigatran 150 mg had the highest NBI, while edoxaban 30 mg had the lowest NBI. The average NBI/patient/year ranged from 63.03 USD – 70.75 USD.

Conclusions

Of all DOACs, edoxaban 30 mg, apixaban 5 mg, and edoxaban 60 mg are the top 3 lowest NBI. Together with cost-effectiveness evidence, those DOACs should be considered to be listed on the National List of Essential Medicine in Thailand.

KEYWORDS:

• Budget impact analysis
• affordability
• direct-acting anticoagulants
• atrial fibrillation
• warfarin

Author contributions

PD and UP contribute to study design, data collection, data analysis, manuscript preparation, and final approval of the manuscript.

Declaration of interest

PD received an honorarium from Pfizer (Thailand) for another project. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers in this manuscript have no relevant financial relationships or otherwise to disclose.

Data availability statement

The data that support the findings of this study are available from the authors upon reasonable request. Please contact corresponding author.

Supplementary Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was not funded by any organizations.