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Prognosis of the influence of direct oral anticoagulants on the direct medical expenses in patients with atrial fibrillation

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Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy.

Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”.

Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment.

Conclusion. Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost. 

About the Authors

S. V. Malchikova
Kirov State Medical University
Russian Federation
MD, Dr Sci Med, Professor of the Department of hospital therapy

112 Karl Marx Str., Kirov 610998, Russia

A. N. Korobeinikova
Center of Cardiology and Neurology
Russian Federation

Oktyabrsky Prospect, 82a, Kirov 610017, Russia


N. S. Maksimchuk-Kolobova
Kirov State Medical University
Russian Federation
MD, PhD, assistant of the Department of polyclinic therapy

112 Karl Marx Str., Kirov 610998, Russia

M. V. Kazakovtseva
Kirov State Medical University
Russian Federation
MD, PhD, associate Professor of the Department of hospital therapy

112 Karl Marx Str., Kirov 610998, Russia


1. Friberg J. Sex-specific increase in the prevalence of atrial fibrillation (The Copenhagen City Heart study). Am J Cardiol. 2003; 15: 1419–1423.

2. Bostrom J. A. Burden of Psychosocial and Cognitive Impairment in Patients With Atrial Fibrillation. Crit Pathw Cardiol. 2016; 16 (2): 71–75.

3. Babkair L. A. Cardioembolic Stroke: A Case Study. Crit Care Nurse. 2017; 37 (1): 27–39.

4. Turakhia M. P. Economic Burden of Undiagnosed Nonvalvular Atrial Fibrillation in the United States. Am J Cardiol. 2015; 116 (5): 733–739.

5. Maksimchuk-Kolobova N. S., Malchikova S. V., Kazakovtseva M. V. Analysis of atrial fibrillation therapy in outpatient settings. Collection of articles of the II International forum of General practitioners. Kirov; N. Novgorod. 2019; 55–58 (in Russ.)

6. Connolly S. J., Ezekowitz M. D., Salim Yusuf, Eikelboom J., Oldgren J., Parekh A., Pogue J., Reilly P. A., Themeles E., Varrone J., Wang S., Alings M., Xavier D., Zhu J., Diaz R., Lewis B. S., Darius H., Diener H-C., Joyner C. D., Wallentin L. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009; 361: 1139–51.

7. Patel M. R., Mahaffey K. W., Garg J., Pan G., Singer D. E., Hacke W., Breithardt G., Halperin J. L., Hankey G. J., Piccini J. P. Сomplete listing of the steering committee members and trial investigators in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism. N Engl J Med. 2011; 365: 883–91.

8. Granger C. B., Alexander J. H., McMurray J.J.V., Lopes R. D., Hylek E. M., Hanna M., Al-Khalidi H.R., Ansell J., Atar D., Avezum A., Bahit C., Diaz R., Easton D., Ezekowitz J. A., Flaker G., Garcia D., Geraldes M., Gersh B. J., Golitsyn S., Goto S., Hermosillo A. G., Hohnloser S. H., Horowitz J., Mohan P., Jansky, P., Lewis B. S., Pais P., Parkhomenko A., Zhu J.. ARISTOTLE Committees and Investigators. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011; 365: 981–92.

9. Malchikova S.V., Maksimchuk-Kolobova N.S., Kazakovtseva M.V. Comorbidity in elderly patients with atrial fibrillation affects the “cost of illness”. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology = FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya. 2019; 12 (3): 191-199 (in Russ.). DOI: 10.17749/2070-4909.2019.12.3.191-199.

10. Tariff agreement on payment of medical care for compulsory medical insurance in the territory of the Kirov region for 2013 from 31.01.2013

11. Quinn, G. R. How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation. Am J Cardiol. 2016; 118 (5): 697–699.

12. Mochizuki A. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation. J Echocardiogr. 2017; 15 (2): 79-87.

For citation:

Malchikova S.V., Korobeinikova A.N., Maksimchuk-Kolobova N.S., Kazakovtseva M.V. Prognosis of the influence of direct oral anticoagulants on the direct medical expenses in patients with atrial fibrillation. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2020;13(2):124-131. (In Russ.)

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)