Open Access Review Article

Pharmacoeconomic Evaluation of Novel Oral Anticoagulants in Patients with Cardiovascular Diseases: A Systematic Review

Ahmed Ibrahim Nouri1, Maha Aldraimly2 and Mohamed Azmi Hassali3

1Washington University for Health and Science, Palestine

2King Abdulaziz Medical City, Saudi Arabia

3Universiti Sains Malaysia, Malaysia

Corresponding Author

Received Date: January 12, 2021;  Published Date: February 04, 2021


Background: Several economic evaluations have been performed in various countries to demonstrate the efficacy of novel oral anticoagulants versus warfarin in patients with cardiovascular diseases. This systematic review aims to provide a comprehensive summarization of the pharmacoeconomic performance of four novel oral anticoagulants, rivaroxaban, apixaban, edoxaban and dabigatran usage in patients with cardiovascular diseases.

Methods: Relevant databases including Embase, Cochrane Library, Medline, CINAHL and Science Direct were used to search for qualitative and quantitative studies. The reviewers independently extracted data according to PRISMA checklist.

Results: There were 43 studies found according to the inclusion criteria. We identified six types of intervention including cost-effectiveness comparison between the novel oral anticoagulants, cost-effectiveness comparison between the novel oral anticoagulants and warfarin, apixaban to warfarin, dabigatran to warfarin, rivaroxaban to warfarin, and edoxaban to warfarin. Outcomes of the interventions included Quality-adjusted Life Year (QALY) , Incremental Cost-effectiveness Ratio (ICER), Incremental Cost-utility Ratio (ICUR), Life Year Gained (LYG), mean-life years, life expectancy, the rate of recurrence, Confidence Interval (CI), willingness-to-pay, number of strokes prevented and types of costs.

Conclusion: Numerous studies investigated novel oral anticoagulants since they were introduced to clinical practice, especially for their various roles in management of cardiovascular diseases. With proven NOAC clinical superiority and the lower need of follow-up visits and lab tests, NOAC economic profile is a broad area of research. The current study managed to review 43 studies investigating NOACs. Despite the variations in quality, sampling, design of studies investigating NOACs, all studies reported that NOAC are more cost-effective than warfarin in terms of indirect costs and quality-adjusted life year.

Keywords: Pharmacoeconomic; Cost-effectiveness; Novel oral anticoagulants; Dabigatran; rivaroxaban; Apixaban; Edoxaban; Cardiovascular diseases

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