A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism.

Introduction Recently, novel oral anticoagulants (rivaroxaban, dabigatran, apixaban) have been approved for pulmonary embolism (PE) treatment. Each anticoagulant used during initial and maintenance therapy has direct and indirect costs for healthcare systems. Demonstrating the costs of treatment with different anticoagulants in a specific patient group will be helpful for clinicians determining treatment strategies. Materials and Methods Retrospective data of 118 patients with PE who were hospitalized and treated with warfarin for at least 3 months were evaluated. Direct medical and nonmedical costs were calculated. True costs with warfarin and modeled costs with rivaroxaban, dabigatran, apixaban and enoxaparine were calculated and compared for maintenance therapy. Estimated costs of initial and maintenance treatment with different anticoagulants were compared for the 49 patients with low complication risk. Result The average total cost of maintenance treatment with warfarin was found to be higher than the novel oral anticoagulants (€286.5 for warfarin, €233.3 for rivaroxaban, €231.7 for dabigatran, and €229.6 for apixaban). In patients with low complication risk, who could be treated without hospitalization, alternative treatment regiments were found to cost less than warfarin treatment (€883.1 for warfarin, €254.3 for rivaroxaban, €238 for apixaban, and €810.6 for enoxaparine). Conclusions Maintenance therapy with novel oral anticoagulant costs less than warfarin treatment. In patients with lower complication risks, alternative regimens that do not require hospitalization could cost less.