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Research Article
28 November 2024

US cost–effectiveness analysis of apixaban compared with warfarin, dabigatran and rivaroxaban for nonvalvular atrial fibrillation, focusing on equal value of life years and health years in total

Authors: Nipun Atreja, Kasper Johannesen, Rupesh Subash [email protected], Carina Bektur, Melissa Hagan, Dionne M Hines, Iulia Dunnett, and Ewa StawowczykAuthor Info & Affiliations
Volume 14, Number 1
https://doi.org/10.57264/cer-2024-0163
PDFFormats

Abstract

Aim: Warfarin and direct-acting oral anticoagulants (DOACs) are widely prescribed to patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of stroke and systemic embolism (SE). This study aimed to assess the cost–effectiveness of apixaban compared with warfarin, dabigatran and rivaroxaban, for patients with NVAF from a US healthcare payer (Medicare) perspective. Methods: A cohort-level Markov model was developed based on a previously published model, for the US setting, factoring in anticipated price decreases due to market entry of generic drugs. Two retrospective cohort studies in US Medicare patients provided inputs to quantify clinical events in the base case setting and in a scenario analysis. For this study, equal value of life-years (evLYs) and health years in total (HYT) were used. Cost–effectiveness was assessed based on a willingness-to-pay threshold of $100,000 per evLY gained (evLYG) or HYT gained (HYTG). Results: Apixaban treatment was associated with gains of 2.23, 1.08 and 1.72 evLYs and 2.26, 1.08 and 1.73 HYTs, compared with warfarin, dabigatran and rivaroxaban, respectively. In the base case analysis from a Medicare perspective, apixaban was cost-effective (i.e., value for money) compared with warfarin, dabigatran and rivaroxaban, with corresponding incremental cost–effectiveness ratio (ICER) per evLYG (and HYTG) of $10,501 ($10,350), $7809 ($7769) and $758 ($768), respectively. When a societal perspective was included, and in a scenario analysis using US Medicare data from the Ray et al. study to quantify treatment effects, apixaban dominated rivaroxaban (i.e., less expensive and more effective) in terms of ICER per evLYG (and HYTG). Conclusion: Using dynamic pricing assumptions, treatment with apixaban compared with warfarin, dabigatran and rivaroxaban was associated with incremental evLYs and HYT and represents a cost-effective treatment option in patients with NVAF, from a US healthcare payer (Medicare) perspective.

Plain language summary

What is this article about?

Atrial fibrillation (AF) is the most common heart rhythm disorder and is a major cause of stroke, which may lead to disability or death. Warfarin and direct-acting oral anticoagulants (DOACs; medicines that help prevent blood clots from forming) are widely used to treat people with nonvalvular atrial fibrillation (NVAF) to lower their risk of stroke and systemic embolism (SE), conditions where clots cause blockages in blood vessels in the brain or elsewhere in the arterial system, respectively. This research aimed to evaluate whether apixaban, a DOAC, is a cost-effective treatment option compared with warfarin, and other DOACs (dabigatran and rivaroxaban) for people with NVAF covered under the Medicare fee-for-service program in the US.

How was the research carried out?

A cost–effectiveness analysis was undertaken using a specially designed mathematical model that analyzed the health benefits (e.g., clinical events such as stroke and major bleeds averted, and years of life gained) and costs of apixaban compared with warfarin, dabigatran and rivaroxaban.

What were the results?

The study showed that apixaban reduced stroke and major bleeding events and was the most cost-effective compared with warfarin, dabigatran and rivaroxaban.

What do the results of the study mean?

The results indicate that for the US Medicare population, using apixaban to treat people with NVAF is a cost-effective treatment option.

Supplementary Material

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References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
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