title: Cost-effectiveness of apixaban versus other new oral anticoagulants for stroke prevention in atrial fibrillation.
abstract: BACKGROUND
  Apixaban (5 mg BID), dabigatran (available as 150 mg and 110 mg BID in Europe), and rivaroxaban (20 mg once daily) are 3 novel oral anticoagulants (NOACs) currently approved for stroke prevention in patients with atrial fibrillation (AF).
  
  
  OBJECTIVE
  The objective of this study was to evaluate the cost-effectiveness of apixaban against other NOACs from the perspective of the United Kingdom National Health Services.
  
  
  METHODS
  A Markov model was developed to evaluate the pharmacoeconomic impact of apixaban versus other NOACs over a lifetime. Pair-wise indirect treatment comparisons were conducted against other NOACs by using ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation), RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy), and ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial results for the following end points: ischemic stroke, hemorrhagic stroke, intracranial hemorrhage, other major bleeds, clinically relevant nonmajor bleeds, myocardial infarction, and treatment discontinuations. Outcomes were life-years, quality-adjusted life years gained, direct health care costs, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  Apixaban was projected to increase life expectancy versus other NOACs, including dabigatran (both doses) and rivaroxaban. A small increase in therapeutic management costs was observed with apixaban due to projected gains in life expectancy and lower discontinuation rates anticipated on apixaban versus other NOACs through lifetime. The estimated incremental cost-effectiveness ratio was £9611, £4497, and £5305 per quality-adjusted life-year gained with apixaban compared with dabigatran 150 mg BID, dabigatran 110 mg BID, and rivaroxaban 20 mg once daily, respectively. Sensitivity analyses indicated that results were robust over a wide range of inputs.
  
  
  CONCLUSIONS
  Although our analysis was limited by the absence of head-to-head trials, based on the indirect comparison data available, our model projects that apixaban may be a cost-effective alternative to dabigatran 150 mg BID, dabigatran 110 mg BID, and rivaroxaban 20 mg once daily for stroke prevention in AF patients from the perspective of the United Kingdom National Health Services.
authors: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk.
authors: Gregory Y H
authors: GY
authors: Lip
authors: Evidera, Bangkok, Thailand.
authors: Thitima
authors: T
authors: Kongnakorn
authors: Bristol-Myers Squibb, Princeton, New Jersey.
authors: Hemant
authors: H
authors: Phatak
authors: Pfizer, New York, New York.
authors: Andreas
authors: A
authors: Kuznik
authors: Evidera, London, United Kingdom.
authors: Tereza
authors: T
authors: Lanitis
authors: Pfizer, New York, New York, Weill Medical College of Cornell University, New York, New York.
authors: Larry Z
authors: LZ
authors: Liu
authors: Alexion Pharmaceuticals, Hartford, Connecticut.
authors: Uchenna
authors: U
authors: Iloeje
authors: Evidera, Lexington, Massachusetts.
authors: Luis
authors: L
authors: Hernandez
authors: University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Paul
authors: P
authors: Dorian
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use*; D000069552:Rivaroxaban; D020521:Stroke / Q000517:prevention & control*; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Stroke prevention; apixaban; atrial fibrillation; cost-effectiveness; new oral anticoagulant