Clinical and economic impact of rivaroxaban on the burden of atrial fibrillation: The case study of Japan.
OBJECTIVE
Atrial fibrillation (AF) affects an estimated 1.5 million individuals in Japan, increasing their stroke risk and imposing considerable costs on the Japanese healthcare system. To reduce stroke incidence, guidelines recommend using anticoagulants in moderate-to-high risk non-valvular AF (NVAF) patients; however, many patients receive no treatment, aspirin only, or remain poorly-controlled on vitamin K antagonists (VKAs) due to high VKA discontinuation rates and non-adherence to guidelines. A prevalence-based Markov model was developed to estimate the clinical and budgetary impact of treating these patients with Xarelto(TM) (rivaroxaban, Bayer AG) in Japan.


METHODS
Population, baseline risk of events, and associated management costs were estimated using data from Japanese publications where available. Treatment efficacy and safety were derived from published data and the J-ROCKET AF trial. Drug and physician visit costs were based on data from the Ministry of Health, Labor, and Welfare, the J-ROCKET AF trial, and Japanese clinical guidelines.


RESULTS
This model demonstrates that increased use of rivaroxaban in inadequately-managed NVAF patients could avoid 456 081 non-fatal ischemic strokes (IS) and 76 975 cardiovascular deaths over 10 years in Japan. This clinical benefit offsets the increased incidence of myocardial infarctions and anticoagulant-related bleeding. Decreased event costs could lead to a ¥188.4 billion decrease in net spending over the analysis time horizon.


CONCLUSIONS
Introducing rivaroxaban may decrease the burden of NVAF in Japanese society. From a clinical perspective, the reduction in IS and embolic events outweighs the increased risk of anticoagulant-related bleeding; from an economic perspective, reduced event costs offset drug and physician visit costs, resulting in cost savings.
a Osaka Medical Centre for Cancer and Cardiovascular Diseases , Osaka, Japan ;
Masatsugu
M
Hori
b International University of Health and Welfare , Otawara, Japan ;
Shunya
S
Ikeda
c Hirosaki University , Hirosaki, Japan ;
Ken
K
Okumura
d University of Occupational and Environmental Health , Kitakyushu, Japan ;
Shinya
S
Matsuda
e Osaka National Hospital , Osaka, Japan ;
Yukihiro
Y
Koretsune
f Covance Market Access , London , UK ;
Calypso
C
Montouchet
g Bayer Yakuhin, Ltd. , Tokyo, Japan ;
Emi
E
Watanabe-Fujinuma
h Bayer Pharma AG , Berlin, Germany.
Thomas
T
Evers
g Bayer Yakuhin, Ltd. , Tokyo, Japan ;
Bruno
B
Rossi
f Covance Market Access , London , UK ;
Lewis
L
Ruff
h Bayer Pharma AG , Berlin, Germany.
Jean-Baptiste
JB
Briere
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D017410:Practice Guidelines as Topic; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use; D020521:Stroke / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban; D001241:Aspirin
Atrial fibrillation; anti-coagulation; budget impact; rivaroxaban; stroke