title: Cost-Effectiveness of High-Dose Edoxaban Compared with Adjusted-Dose Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation Patients.
abstract: OBJECTIVE
  To estimate the quality-adjusted life-years (QALYs), costs, and cost-effectiveness of high-dose edoxaban compared with adjusted-dose warfarin in patients at risk for stroke who have nonvalvular atrial fibrillation (NVAF) and a creatinine clearance (Clcr ) of 15-95 ml/minute.
  
  
  METHODS
  A Markov model was created to compare the cost-effectiveness of high-dose edoxaban and adjusted-dose warfarin in patients with a Clcr of 15-95 ml/minute. The model was performed from a U.S. societal perspective and assumed patients initiated therapy at 70 years of age, had a mean CHADS2 (congestive heart failure, hypertension, age 75 or older, diabetes, stroke) score of 3, and no contraindications to anticoagulation. The model assumed a cycle length of 1 month and a lifetime horizon (maximum of 30 years/360 cycles). Data sources included renal subgroup analysis of the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation (ENGAGE-AF) trial and other published studies. Outcomes included lifetime costs (2014 US$), QALYs, and incremental cost-effectiveness ratios. The robustness of the model's conclusions was tested using one-way and 10,000-iteration probabilistic sensitivity analysis (PSA).
  
  
  RESULTS
  Patients treated with high-dose edoxaban lived an average of 10.50 QALYs at a lifetime treatment cost of $99,833 compared with 10.11 QALYs and $123,516 for those treated with adjusted-dose warfarin. The model's conclusions were found to be robust upon one-way sensitivity analyses. PSA suggested high-dose edoxaban was economically dominant compared with adjusted-dose warfarin in more than 99% of the 10,000 iterations run.
  
  
  CONCLUSIONS
  High-dose edoxaban appears to be an economically dominant strategy when compared with adjusted-dose warfarin for the prevention of stroke in NVAF patients with a Clcr of 15-95 ml/minute and an appreciable risk of stroke.
authors.affiliation: University of Connecticut, School of Pharmacy, Storrs, Connecticut.|Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
authors.forename: Elaine
authors.initials: E
authors.lastname: Nguyen
authors.affiliation: University of Connecticut, School of Pharmacy, Storrs, Connecticut.
authors.forename: Florence
authors.initials: F
authors.lastname: Egri
authors.affiliation: Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Mearns
authors.affiliation: University of Connecticut, School of Pharmacy, Storrs, Connecticut.|Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
authors.forename: Charles M
authors.initials: CM
authors.lastname: White
authors.affiliation: University of Connecticut, School of Pharmacy, Storrs, Connecticut.|Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000191:economics* / Q000517:prevention & control; D013844:Thiazoles / Q000191:economics* / Q000627:therapeutic use; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011725:Pyridines; D013844:Thiazoles; D014859:Warfarin; C552171:edoxaban
keywords: Markov model; anticoagulation; atrial fibrillation; cost-effectiveness; stroke