OBJECTIVES: To compare the total costs of different drug strategies in the treatment of venous thromboembolism (VTE) in Denmark, including prevention of recurrent VTE. Secondly, the implications of different cost perspectives from the most narrow drug budget perspective to the widest societal perspective are illustrated.

METHODS: In a costs analysis, treatment of VTE patients with the Non-vitamin K-antagonist oral anticoagulants (NOACs) apixaban, dabigatran, edoxaban or rivaroxaban are pairwise compared with low-molecular-weight heparin (LMWH) + vitamin K antagonist (VKA). The relative risk of having recurrent VTE event and the risk of major bleeding are based on significant results from clinical phase 3 trials. The analysis of six months costs of treatment is made for five cost perspectives: Drug only; drug and visits; healthcare sector; public sector; and societal perspective. Costs included are: Drugs, GP/specialist visits for INR-monitoring and control, 3-year present value of VTE events and major bleedings, and lost production due to disease and early death.

RESULTS: In the Drug only perspective LMWH+VKA is the least costly option compared with all NOACs. When adding GP/specialist visits the costs of LMWH+VKA is almost on par with NOACs (visit perspective). When costs of recurrent VTE episodes and major bleedings are added (healthcare sector perspective) apixaban (€868) and rivaroxaban (€922) becomes the least costly options per patient’s 6 months treatment. Finally, when costs of social care and production lost are added in the public sector and/or societal perspectives, all NOACs becomes less costly. Apixaban is associated with lowest societal cost of 6 months treatment (€1,872) followed by rivaroxaban (€2,041), dabigatran (€2,649) and edoxaban (€2,777).

CONCLUSIONS: In countries where decisions regarding use of drugs are based on drug costs only, the estimate of treatment costs is misleading. The present study shows that decisions should be based on as broad a cost perspective as possible.