title: Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting.
abstract: BACKGROUND
  Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines.
  
  
  OBJECTIVE
  The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk.
  
  
  METHODS
  A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature.
  
  
  RESULTS
  Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.
  
  
  CONCLUSIONS
  The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.
authors.affiliation: Deloitte Health Economics and Outcomes Research Group, Brussels, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Kleintjens
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: Marnix
authors.initials: M
authors.lastname: Goethals
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Rietzschel
authors.forename: Yumi
authors.initials: Y
authors.lastname: Asukai
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Saka
authors.forename: Thomas
authors.initials: T
authors.lastname: Evers
authors.forename: Petra
authors.initials: P
authors.lastname: Faes
authors.forename: Stefaan
authors.initials: S
authors.lastname: Vansieleghem
authors.forename: Mimi
authors.initials: M
authors.lastname: De Ruyck
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D001530:Belgium; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D009025:Morpholines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D000069552:Rivaroxaban; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D013876:Thiophenes / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D014859:Warfarin; D000069552:Rivaroxaban
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