Cost-Effectiveness 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: Anticoagulants are essential for managing thromboembolic and cardiovascular diseases. In Algeria, vitamin K antagonists (VKAs) remain the standard treatment due to their inclusion in the public reimbursement system. In contrast, direct oral anticoagulants (DOACs), while offering clear clinical and practical advantages, remain unreimbursed and relatively expensive, which limits access and raises concerns about their value in resource-constrained healthcare settings. This study aims to evaluate the cost-effectiveness of DOACs compared to VKAs from the perspective of the Algerian healthcare system, considering clinical outcomes, quality-adjusted life years (QALYs), and healthcare resource utilization.
METHODS: A cost-utility analysis was conducted using a decision-analytic model comparing DOACs to VKAs over a one-year time horizon. The analysis included direct medical costs related to drug acquisition, biological monitoring, and management of bleeding complications. Clinical effectiveness was measured in QALYs using utility values derived from EQ-5D-3L scores collected in a published cross-sectional study of patients receiving oral anticoagulants. The Incremental Cost-Effectiveness Ratio (ICER) was calculated, and sensitivity analyses were performed to assess robustness.
RESULTS: in the base-case scenario, DOACs resulted in an incremental gain of 0.060 QALYs per patient compared to VKAs. Although the per-patient cost of DOACs was higher—primarily due to drug acquisition—this was partially offset by improved outcomes. The incremental cost per patient was estimated at 526.45 USD, resulting in an ICER of 8,526.81 USD per QALY gained. Sensitivity analyses confirmed result robustness and identified DOAC pricing as a key cost driver.
CONCLUSIONS: In the Algerian context, DOACs show a favorable cost-effectiveness profile versus VKAs by improving outcomes and reducing complication-related costs. These findings highlight the importance of considering not only economic and clinical factors but also quality of life in therapeutic decisions. DOACs warrant broader inclusion in clinical guidelines and reimbursement policies.
METHODS: A cost-utility analysis was conducted using a decision-analytic model comparing DOACs to VKAs over a one-year time horizon. The analysis included direct medical costs related to drug acquisition, biological monitoring, and management of bleeding complications. Clinical effectiveness was measured in QALYs using utility values derived from EQ-5D-3L scores collected in a published cross-sectional study of patients receiving oral anticoagulants. The Incremental Cost-Effectiveness Ratio (ICER) was calculated, and sensitivity analyses were performed to assess robustness.
RESULTS: in the base-case scenario, DOACs resulted in an incremental gain of 0.060 QALYs per patient compared to VKAs. Although the per-patient cost of DOACs was higher—primarily due to drug acquisition—this was partially offset by improved outcomes. The incremental cost per patient was estimated at 526.45 USD, resulting in an ICER of 8,526.81 USD per QALY gained. Sensitivity analyses confirmed result robustness and identified DOAC pricing as a key cost driver.
CONCLUSIONS: In the Algerian context, DOACs show a favorable cost-effectiveness profile versus VKAs by improving outcomes and reducing complication-related costs. These findings highlight the importance of considering not only economic and clinical factors but also quality of life in therapeutic decisions. DOACs warrant broader inclusion in clinical guidelines and reimbursement policies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE245
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)