Budget Impact Analysis of Direct Oral Anticoagulants vs. Vitamin K Antagonists in Algeria: A Public Payer Perspective
Author(s)
Razika Igoud, PharmD1, Mohamed Sidi Ali, MBA, PharmD2, Leila Adda Abbou, Ph.D.in pharmacology1.
1Faculty of Pharmacy, University of Algiers, Algiers, Algeria, 2CISSSO – Quebec Health (Integrated Health and Social Services Center of the Outaouais), Aylmer, QC, Canada.
1Faculty of Pharmacy, University of Algiers, Algiers, Algeria, 2CISSSO – Quebec Health (Integrated Health and Social Services Center of the Outaouais), Aylmer, QC, Canada.
OBJECTIVES: Oral anticoagulants play a crucial role in preventing stroke and thromboembolic complications in patients with atrial fibrillation and other cardiovascular conditions. In Algeria, vitamin K antagonists (VKAs) remain the predominant option for oral anticoagulation, largely due to their inclusion in the public reimbursement system. In contrast, direct oral anticoagulants (DOACs), despite their proven clinical effectiveness, are not reimbursed and remain costly, which significantly limits their accessibility. This study aims to evaluate the budget impact of introducing reimbursement for DOACs in Algeria, compared to the current policy where only VKAs are covered, from a public payer perspective.
METHODS: A budget impact model was developed for a target population of 496,786 patients eligible for oral anticoagulation, based on national prevalence and hospital utilization data. Two scenarios were compared over a three-year horizon: (1) the existing model reimbursing only VKAs, with DOACs paid out-of-pocket; and (2) an expanded policy covering both VKAs and DOACs. The model incorporated drug acquisition costs, biological monitoring costs, and bleeding-related hospitalization costs. Univariate sensitivity analyses varied key parameters by ±20%.
RESULTS: The total annual cost of anticoagulant therapy was estimated at $16.57 million. DOACs accounted for 76% of total expenditures, mainly driven by higher per-patient drug costs ($657.70 vs. $131.30 for VKAs). However, DOAC use led to a 29%$ reduction in biological monitoring costs and a 62%$ decrease in bleeding-related hospitalization costs. The incremental three-year budget impact was $79.66 million. Sensitivity analyses confirmed the robustness of these results and suggested that DOAC price reductions could improve cost-effectiveness.
CONCLUSIONS: Although DOACs are more expensive than VKAs, their reimbursement could enhance resource efficiency by simplifying patient management and reducing complications, while also improving treatment adherence and clinical effectiveness. With potential price reductions, this strategy may offer sustainable value for the healthcare system.
METHODS: A budget impact model was developed for a target population of 496,786 patients eligible for oral anticoagulation, based on national prevalence and hospital utilization data. Two scenarios were compared over a three-year horizon: (1) the existing model reimbursing only VKAs, with DOACs paid out-of-pocket; and (2) an expanded policy covering both VKAs and DOACs. The model incorporated drug acquisition costs, biological monitoring costs, and bleeding-related hospitalization costs. Univariate sensitivity analyses varied key parameters by ±20%.
RESULTS: The total annual cost of anticoagulant therapy was estimated at $16.57 million. DOACs accounted for 76% of total expenditures, mainly driven by higher per-patient drug costs ($657.70 vs. $131.30 for VKAs). However, DOAC use led to a 29%$ reduction in biological monitoring costs and a 62%$ decrease in bleeding-related hospitalization costs. The incremental three-year budget impact was $79.66 million. Sensitivity analyses confirmed the robustness of these results and suggested that DOAC price reductions could improve cost-effectiveness.
CONCLUSIONS: Although DOACs are more expensive than VKAs, their reimbursement could enhance resource efficiency by simplifying patient management and reducing complications, while also improving treatment adherence and clinical effectiveness. With potential price reductions, this strategy may offer sustainable value for the healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE82
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Budget Impact Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas