title: Cost-effectiveness of apixaban versus warfarin and aspirin in Sweden for stroke prevention in patients with atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF), one of the major risk factors for stroke, imposing a substantial burden to the Swedish health care system. Apixaban has demonstrated superiority to warfarin and aspirin in stroke prevention amongst patients with AF in two large randomised clinical trials. The aim of this study was to assess the economic implications of apixaban against warfarin and aspirin in these patients from a Swedish societal perspective.
  
  
  METHODS
  A Markov cohort model was constructed to characterise the consequences of anticoagulant treatment with regards to thromboembolic and bleeding events, as well as the associated health care costs, life-years and quality-adjusted life years (QALYs) for patients with AF treated with apixaban, warfarin or aspirin. Incremental cost-effectiveness ratios (ICERs) per QALY gained of apixaban relative to warfarin (among patients suitable for warfarin treatment) and aspirin (among patients unsuitable for warfarin treatment) were calculated. Costs (in 2011 SEKs) and QALYs were discounted at 3% per annum.
  
  
  RESULTS
  The model estimated the ICER of apixaban versus warfarin amongst patients who are suitable for warfarin therapy to be SEK 33,458/QALY gained and that of apixaban versus aspirin amongst those unsuitable for warfarin therapy to be SEK 41,453/QALY gained. Probabilistic sensitivity analyses indicate that apixaban is an optimal treatment option compared with warfarin and aspirin, when the willingness-to-pay is above SEK 35,000 and SEK 45,000 per QALY, respectively.
  
  
  CONCLUSIONS
  Apixaban was found to be a cost-effective alternative to warfarin and aspirin for stroke prevention in patients with AF in Sweden.
authors.affiliation: Evidera, 1 Butterwick, London, W6 8DL, United Kingdom. Electronic address: tereza.lanitis@evidera.com.
authors.forename: Tereza
authors.initials: T
authors.lastname: Lanitis
authors.affiliation: Evidera, 1 Butterwick, London, W6 8DL, United Kingdom. Electronic address: thitima.kongnakorn@evidera.com.
authors.forename: Thitima
authors.initials: T
authors.lastname: Kongnakorn
authors.affiliation: BMS, Hemvärnsgatan 9, SE-171 54 Solna, Sweden. Electronic address: lena.jacobson@bms.com.
authors.forename: Lena
authors.initials: L
authors.lastname: Jacobson
authors.affiliation: Pfizer, Pfizer AB, Vetenskapsvägen 10, SE-191 90 Sollentuna. Electronic address: anna.degeer@pfizer.com.
authors.forename: Anna
authors.initials: A
authors.lastname: De Geer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013548:Sweden / Q000453:epidemiology; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D001241:Aspirin
keywords: Apixaban; Aspirin; Atrial fibrillation; Cost-effectiveness; Warfarin