VKA-to-DOAC transition and generic savings potential in Spain, 2010–2024
Abstract
Background: Oral anticoagulation prevents cardioembolic stroke and venous thromboembolism. In Spain, poor control of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation and current recommendations support prioritising direct oral anticoagulants (DOACs). This study describes Spain’s transition from VKAs to DOACs and estimates expenditure and potential generic savings.
Methods: Ecological drug-utilisation study using national consumption data for acenocoumarol, warfarin, dabigatran, rivaroxaban, apixaban and edoxaban (ATC B01AA, B01AE07, B01AF01–03) from 2010 to 2024, expressed as DDD/1,000 inhabitants/day. Trends by substance and ATC group were analysed. For 2024, retail expenditure including VAT was described and a 30% price-reduction scenario for generic rivaroxaban, apixaban and edoxaban was modelled.
Results: Between 2010 and 2024, oral antithrombotic exposure almost tripled, from 6.62 to 18.22 DDD/1,000/day. VKAs remained around 6.5–7.0 until 2016 and then declined to 4.34 in 2024, mainly due to acenocoumarol, while warfarin stayed near 0.4–0.5. Dabigatran rose from 0.04 to 1.62 DDD/1,000/day and factor Xa inhibitors from near zero to 12.26, led by apixaban (5.51), rivaroxaban (3.48) and edoxaban (3.28). DOACs accounted for about 76% of oral anticoagulant exposure. In 2024, expenditure reached €793.2 million; VKAs represented €15.7 million (≈2%), while DOACs accounted for 98%. A 30% price reduction for generic rivaroxaban, apixaban and edoxaban would generate potential annual savings of €194.4 million, about 25% of current spending, without reducing exposure.
Conclusions: Spain has shifted to a DOAC-dominated anticoagulation model, although residual VKA use remains clinically relevant. Most spending is now concentrated in DOACs, so maintaining VKA use offers limited economic benefit while preserving avoidable risk. DOAC generics could create a major efficiency margin to improve NVAF detection, anticoagulation quality and equitable access.
Key messages: • Spain has shifted to a DOAC-dominated anticoagulation model, while residual VKA use remains clinically relevant.
• DOAC generics could save €194.4 million annually in Spain, creating efficiency gains to improve detection, quality and equity.
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BibTeX
@article{ortells2026vkatodoac,
title = {{VKA-to-DOAC transition and generic savings potential in Spain, 2010–2024}},
author = {S Granero Ortells and N Bermudez Repiso and I Barrachina Martinez and JL Trillo Mata},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1834},
url = {https://doi.org/10.1093/eurpub/ckag169.1834},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - VKA-to-DOAC transition and generic savings potential in Spain, 2010–2024
AU - S Granero Ortells
AU - N Bermudez Repiso
AU - I Barrachina Martinez
AU - JL Trillo Mata
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1834
UR - https://doi.org/10.1093/eurpub/ckag169.1834
AB - Background: Oral anticoagulation prevents cardioembolic stroke and venous thromboembolism. In Spain, poor control of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation and current recommendations support prioritising direct oral anticoagulants (DOACs). This study describes Spain’s transition from VKAs to DOACs and estimates expenditure and potential generic savings. Methods: Ecological drug-utilisation study using national consumption data for acenocoumarol, warfarin, dabigatran, rivaroxaban, apixaban and edoxaban (ATC B01AA, B01AE07, B01AF01–03) from 2010 to 2024, expressed as DDD/1,000 inhabitants/day. Trends by substance and ATC group were analysed. For 2024, retail expenditure including VAT was described and a 30% price-reduction scenario for generic rivaroxaban, apixaban and edoxaban was modelled. Results: Between 2010 and 2024, oral antithrombotic exposure almost tripled, from 6.62 to 18.22 DDD/1,000/day. VKAs remained around 6.5–7.0 until 2016 and then declined to 4.34 in 2024, mainly due to acenocoumarol, while warfarin stayed near 0.4–0.5. Dabigatran rose from 0.04 to 1.62 DDD/1,000/day and factor Xa inhibitors from near zero to 12.26, led by apixaban (5.51), rivaroxaban (3.48) and edoxaban (3.28). DOACs accounted for about 76% of oral anticoagulant exposure. In 2024, expenditure reached €793.2 million; VKAs represented €15.7 million (≈2%), while DOACs accounted for 98%. A 30% price reduction for generic rivaroxaban, apixaban and edoxaban would generate potential annual savings of €194.4 million, about 25% of current spending, without reducing exposure. Conclusions: Spain has shifted to a DOAC-dominated anticoagulation model, although residual VKA use remains clinically relevant. Most spending is now concentrated in DOACs, so maintaining VKA use offers limited economic benefit while preserving avoidable risk. DOAC generics could create a major efficiency margin to improve NVAF detection, anticoagulation quality and equitable access. Key messages: • Spain has shifted to a DOAC-dominated anticoagulation model, while residual VKA use remains clinically relevant. • DOAC generics could save €194.4 million annually in Spain, creating efficiency gains to improve detection, quality and equity.
SN - 1101-1262
SN - 1464-360X
ER -