PhD defence L.A. (Lisa) de Jong

Health economics of direct oral anticoagulants in the Netherlands.

Blood thinners (anticoagulation) are used for the prevention of venous thromboembolism and to prevent stroke in patients with atrial fibrillation. Vitamin K antagonists (VKAs) have been the standard in oral anticoagulation since the 1950s, but in 2008, a new type of anticoagulant was introduced to the market: the direct oral anticoagulants (DOACs). Clinical trials show that DOACs have a better effectiveness/safety balance compared to VKAs. DOACs are also beneficial because, unlike VKAs, they do not require monitoring of blood clotting time; however, the medication costs of DOACs are higher. For this reason, the Health Council of the Netherlands opted for a conservative introduction of DOACs while the Dutch government asked for an investigation into their cost-effectiveness based on real-world data. Cost-effectiveness analysis is a form of economic analysis that enables the assessment of whether the difference in risk/benefit balance outweighs the difference in medication and monitoring costs. The aim of the thesis of Lisa de Jong was to demonstrate the cost-effectiveness of a broad implementation of DOACs for patients with atrial fibrillation and venous thromboembolism in the Netherlands based on both clinical trial and real-world data.The results based on clinical trial data showed that DOACs are cost-effective compared to VKAs for stroke prevention in patients with atrial fibrillation. Moreover, DOACs are even cost-saving compared to VKAs for the prevention of venous thromboembolism. This was confirmed by the cost-effectiveness analyses based on real-world data. As attested by these results, there was no reason for a conservative introduction of DOACs on the basis of cost-effectiveness.

Promotor: Prof.dr. M.J. Postma