title: Cost-utility analysis of oral anticoagulants for nonvalvular atrial fibrillation patients at the police general hospital, Bangkok, Thailand.
abstract: OBJECTIVE
  The genetic polymorphism was one of the major considerations for adjusting doses of warfarin in Thai individuals. As a result, new oral anticoagulants (NOACs) were introduced to achieve therapeutic goals in stroke prevention in atrial fibrillation (SPAF) patients. However, a cost-utility analysis in a population-specific model was lacking in Thailand. This study was performed to determine which NOACs yielded population-specific, cost-effective results for SPAF compared with warfarin from both governmental and societal perspectives in Thailand.
  
  
  METHODS
  A simplified Markov health state model was constructed to calculate the lifetime cost, life-years saved, and quality-adjusted life-years (QALYs) gained. Asia-specific clinical event parameters were defined from systematic searches of PubMed. Cost and utility input was obtained from hospital based data collection.
  
  
  RESULTS
  Although NOACs produced more life-years saved and QALYs gained resulting from the base-case versus warfarin, the lifetime costs of new alternatives increased to >1.4 times the comparative cost of warfarin. This caused an incremental cost-effective ratio that exceeded Thailand's cost-effectiveness threshold. The probabilistic sensitivity analysis denoted the robustness of our model and revealed that dose-adjusted warfarin was the most cost-effective option in >99% of iterations. NOACs produced cost-effective results when the medication unit cost was decreased by at least 85%.
  
  
  CONCLUSIONS
  According to the results of this first cost-utility analysis in Thailand, warfarin is still the most cost-effective medication for SPAF from any perspective in Thailand at the threshold recommended by our health technology assessment guidelines.
authors.affiliation: Pharmacy Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Siriporn
authors.initials: S
authors.lastname: Jarungsuccess
authors.affiliation: Pharmacy Department, Police General Hospital, Bangkok, Thailand. Electronic address: pitsanu.kung@gmail.com.
authors.forename: Satadon
authors.initials: S
authors.lastname: Taerakun
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics*; D002947:Cities; D003362:Cost-Benefit Analysis; D006769:Hospitals, General; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D016495:Police; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000517:prevention & control; D013785:Thailand; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Asian; atrial fibrillation; cost utility; new oral anticoagulant; stroke