Health economics of direct oral anticoagulants in the Netherlands

Blood thinners (anticoagulation) are used for the prevention of venous thromboembolism and to prevent stroke in patients with atrial fibrillation. Vitamin K antagonists (VKAs) have been the standard in oral anticoagulation since the 1950s, but in 2008, a new type of anticoagulant was introduced to the market: the direct oral anticoagulants (DOACs).
Clinical trials show that DOACs have a better effectiveness/safety balance compared to VKAs. DOACs are also beneficial because, unlike VKAs, they do not require monitoring of blood clotting time; however, the medication costs of DOACs are higher. For this reason, the Health Council of the Netherlands opted for a conservative introduction of DOACs while the Dutch government asked for an investigation into their cost-effectiveness based on real-world data. Cost-effectiveness analysis is a form of economic analysis that enables the assessment of whether the difference in risk/benefit balance outweighs the difference in medication and monitoring costs.
The aim of this thesis was to demonstrate the cost-effectiveness of a broad implementation of DOACs for patients with atrial fibrillation and venous thromboembolism in the Netherlands based on both clinical trial and real-world data.
The results based on clinical trial data showed that DOACs are cost-effective compared to VKAs for stroke prevention in patients with atrial fibrillation. Moreover, DOACs are even cost-saving compared to VKAs for the prevention of venous thromboembolism. This was confirmed by the cost-effectiveness analyses based on real-world data. As attested by these results, there was no reason for a conservative introduction of DOACs on the basis of cost-effectiveness.