OBJECTIVES: To assess, from the perspective of the Egyptian health sector, the cost-effectiveness of the combined use of warfarin and low-dose aspirin (75 mg) versus that of warfarin alone in patients with mechanical heart valve prostheses that began therapy between the ages of 15 to 50 years.

METHODS: An economic evaluation was conducted alongside a randomized, controlled trial to assess the cost-effectiveness of the combined therapy in patients with mechanical valve prostheses. A total of 316 patients with an age between 15 and 50 years were included in the study and randomly assigned to a treatment that combined warfarin and aspirin or that used warfarin alone.

RESULTS: :Patients in the combined therapy group had a significant longer duration of protection against the first event. There were fewer primary events in the warfarin plus aspirin arm than in the warfarin arm (1.4%/ year, versus 4.8%/ year), and the mean quality-adjusted life years score in the warfarin plus aspirin arm was higher; however, the difference did not reach conventional levels of statistical significance. Total costs over 4 years were lower in the combined therapy (difference, -$244; 95% CI, -$483.1 to $3.8), which yielded an incremental cost-effectiveness ratio of -4603 for warfarin plus aspirin. Thus, the combined therapy was dominant.

CONCLUSIONS: From the perspective of the Egyptian health sector, addition of aspirin to warfarin is more effective and less costly than warfarin alone for patients with mechanical valve prostheses. This combined strategy could be adopted for patients to prevent the complications of mechanical valve prostheses. The present study adds to the body of evidence supporting warfarin plus aspirin option in patients with mechanical valve prostheses.