OBJECTIVES: Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with an increased risk of thromboembolic and cerebral complications, significantly impacting public health. In Algeria for instance, where only vitamin-K agonists (VKA) are reimbursed, stroke is a leading cause of mortality, representing 15.6% of all deaths in 2012. The present study aimed to estimate the clinical and economic burden of non-valvular AF (NVAF) and whether dabigatran could help address it.

METHODS: We first reviewed literature to identify the epidemiological burden of the disease. Next, six hospital centres and one private clinic were surveyed on consumed resources and unit costs for treatment and management of stroke prevention in NVAF and associated complications. Results were then combined with event probabilities from the RE-LY trial in an economic model to estimate the annual cost of NVAF prevention and complications for the Algerian healthcare system, and the potential impact of introducing dabigatran.

RESULTS: Epidemiology data suggest 187,686 patients suffer from NVAF in Algeria. 70% were treated with VKA, with an annual direct medical cost of €59.1M (€548 average per patient), distributed as: €1.12M drug costs (2.0%), €1.44M INR monitoring (2.4%), €38.7M hospitalisation costs (65.5%) and €17.8M 1-year post-discharge costs (30.1%). Even though only 47.6% of patients were uncontrolled, they represented 82.9% of clinical events (41,055) and 81.6% of costs (€48.2M). The introduction of dabigatran in this uncontrolled population could avoid 34,453 events (-83.9%), 5,867 deaths (-85.1%) per year, and despite a drug cost increase of €37.0M, it could decrease total costs by 7.7% to €44.5M.

CONCLUSIONS: The absence of therapeutic alternatives in Algeria for uncontrolled patients places a significant clinical and economic burden on the healthcare system, mostly through hospital costs. Dabigatran showed a potential to reduce the number of clinical events and deaths, freeing up hospital resources and generating moderate savings on healthcare budgets.