OBJECTIVE
To evaluate clinical efficacy and efficiency of new oral anticoagulants (NOACs) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors in patients with coronary artery disease and concomitant cardiovascular diseases in national healthcare system.
MATERIAL AND METHODS
The mathematical model assessed clinical efficacy and efficiency of 2 groups of drugs: 1) NOACs (apixaban, dabigatran and rivaroxaban) compared to warfarin in patients with coronary artery disease and atrial fibrillation (AF); 2) SGLT-2 inhibitors (dapagliflozin and empagliflozin) in addition to standard treatment compared to standard treatment without SGLT-2 inhibitors in patients with coronary artery disease and chronic heart failure (CHF) with ejection fraction (EF) <40%. Prediction of all-cause mortality was based on clinical trials after previous systematic searching of appropriate data. We estimated direct medical costs of NOACs and SGLT-2 inhibitors, as well as indirect costs following losses in gross domestic product, cost of prevented death and economic effect per 1 ruble invested.
RESULTS
Fewer deaths and higher costs are expected in patients with coronary artery disease and AF receiving NOACs compared to warfarin. The cost of 1 prevented death ranged from 18.75 to 14.63 million rubles. Economic effect per 1 additionally invested ruble for 1, 3 and 7 years was 0.06, 0.124 and 0.267 rubles, respectively. Fewer deaths and higher costs are also assumed in patients with coronary artery disease and CHF (EF <40%) receiving SGLT-2 inhibitors+standard treatment compared to standard treatment alone. The cost of 1 prevented death ranged from 7.93 to 3.81 million rubles. Economic effect per 1 additionally invested ruble for 1, 3 and 7 years was 0.132, 0.271 and 0.583 rubles, respectively.
CONCLUSION
New anticoagulants in patients with coronary artery disease and atrial fibrillation, as well as SGLT-2 inhibitors in patients with chronic heart failure and EF <40% can reduce mortality. Necessary additional costs will be partially offset by lower indirect costs associated with losses in gross domestic product. The cost of prevented death is lower in cohort of patients with coronary artery disease and chronic heart failure receiving SGLT-2 inhibitors compared to patients with coronary artery disease and atrial fibrillation receiving new anticoagulants. Economic effect per 1 ruble invested for SGLT-2 inhibitors exceeds the effect for new anticoagulants.