Cost Effectiveness Analysis for Combination of Aspirin and Warfarin versus Warfarin Alone in Patients with Heart Valve Prosthesis

Abstract

The use of a combined therapy of an antiplatelet and an anticoagulant versus anticoagulant alone to reduce the thromboembolic events in patients with heart valve prostheses is an established standard of care, but this therapy is not considered as a protocol in Egypt. A previous Markov model cost-effectiveness study on Egyptian patients aged 50 to 60 years demonstrated that the combined therapy reduced the overall cost. However, with the lack of actual real world data on cost-effectiveness and the limitation of the Markov model study to 50- to 60-year-old patients, the Egyptian medical community is still questioning if the added benefit is worth the cost. Objective: 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 who 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.