Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation
AR Harrington, EP Armstrong, PE Nolan Jr, DC Malone - Stroke, 2013 - Am Heart Assoc
AR Harrington, EP Armstrong, PE Nolan Jr, DC Malone
Stroke, 2013•Am Heart AssocBackground and Purpose—To estimate the cost-effectiveness of stroke prevention in
patients with nonvalvular atrial fibrillation by using novel oral anticoagulants apixaban 5 mg,
dabigatran 150 mg, and rivaroxaban 20 mg compared with warfarin. Methods—A Markov
decision-analysis model was constructed using data from clinical trials to evaluate lifetime
costs and quality-adjusted life-years of novel oral anticoagulants compared with warfarin.
The modeled population was a hypothetical cohort of 70-year-old patients with nonvalvular …
patients with nonvalvular atrial fibrillation by using novel oral anticoagulants apixaban 5 mg,
dabigatran 150 mg, and rivaroxaban 20 mg compared with warfarin. Methods—A Markov
decision-analysis model was constructed using data from clinical trials to evaluate lifetime
costs and quality-adjusted life-years of novel oral anticoagulants compared with warfarin.
The modeled population was a hypothetical cohort of 70-year-old patients with nonvalvular …
Background and Purpose
To estimate the cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation by using novel oral anticoagulants apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg compared with warfarin.
Methods
A Markov decision-analysis model was constructed using data from clinical trials to evaluate lifetime costs and quality-adjusted life-years of novel oral anticoagulants compared with warfarin. The modeled population was a hypothetical cohort of 70-year-old patients with nonvalvular atrial fibrillation, increased risk for stroke (CHADS2≥ 1), renal creatinine clearance≥ 50 mL/min, and no previous contraindications to anticoagulation. The willingness-to-pay threshold was 50000/quality-adjustedlife-yearsgained.
Results
Inthebasecase,warfarinhadthelowestcostof 77 813 (SD, 2223),followedbyrivaroxaban20mg( 78 738±1852),dabigatran150mg( 82 719±1959),andapixaban5mg( 85 326±1512).Apixaban5mghadthehighestquality-adjustedlife-yearsestimateat8.47(SD,0.06),followedbydabigatran150mg(8.41±0.07),rivaroxaban20mg(8.26±0.06),andwarfarin(7.97±0.04).InaMonteCarloprobabilisticsensitivityanalysis,apixaban5mg,dabigatran150mg,rivaroxaban20mg,andwarfarinwerecost-effectivein45.1%,40%,14.9%,0%ofthesimulations,respectively.
Conclusions
Inpatientswithnonvalvularatrialfibrillationandanincreasedriskofstrokeprophylaxis,apixaban5mg,dabigatran150mg,andrivaroxaban20mgwereallcost-effectivealternativestowarfarin.Thecost-effectivenessofnoveloralanticoagulantsswasdependentontherapypricingintheUnitedStatesandneurologicaleventsassociatedwithrivaroxaban20mg.
Am Heart Assoc
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