PHARMACOECONOMIC EVALUATION OF ORAL ANTICOAGULANTS ADMINISTRATION IN PATIENTS WITH DEEP VEINS THROMBOSIS
Objective. Assessment of the rivaroxaban and dabigatran etexilate feasibility for treating and preventing venous thromboembolism in the Republic of Belarus based on the pharmacoeconomic analysis data.
Materials and methods. A systematic review of the data related to the rivaroxaban and dabigatran etexilate administration in patients with the deep veins thrombosis available in literature and electronic databases has been performed. The market prices of medicinal drugs in the Republic of Belarus have been analyzed. The standard pharmacoeconomic methods such as analysis of "cost minimization", "illness cost", "cost/effectiveness", and "impact on he budget" have been used. A model of "decision tree" has been constructed for making decision on the anticoagulants (rivaroxaban, dabigatran etexilate, and warfarin) appliance within the outpatient management of patients with deep veins thrombosis accompanied by assessment of the clinically important action of medicinal products on the treatment outcomes. One-sided deterministic sensitivity analysis has been performed without the costs discounting.
Results. Warfarin is the least costly option of the in-hospital treatment (BYN 67.47 per course of treatment in a hospital). Of the new anticoagulants the rivaroxaban treatment course (14 days) (enoxaparin sodium 2 days с rivaroxaban 1S mg times a day) cost is 1.7 times higher compared with the dabigatran etexilate application scheme (enoxaparin sodium Sdays с dabigatran etexilate 150 mg of 2 times a day). The "cost/effectiveness" ratio in case of dabigatran etexilate administration per a patient (BYN 1 188.9) is lower than in case of the rivaroxaban administration (BYN 1 380.4). The dabigatran etexilate therapy when it is used instead of rivaroxaban allows reduce costs by 11.4% per 1,000 patients treated outpatient.
Conclusion. The effective treatment cost of one patient is higher when NOACs are used in comparison with the warfarin administration taking into account but the direct medical costs. The dabigatran etexilate prescription is the dominant technology in value terms compared with the rivaroxaban one in treating and preventing the deep veins thrombosis in the lower extremities as concerns the health system of the Republic of Belarus.