Cost-effectiveness of edoxaban versus rivaroxaban for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the US.
BACKGROUND
Understanding the value of new anticoagulation therapies compared with existing therapies is of paramount importance in today's cost-conscious and efficiency-driven health care environment. Edoxaban and rivaroxaban for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with CHADS2 scores ≥2 have been evaluated in pivotal trials versus warfarin. The relative value of edoxaban versus rivaroxaban would be of interest to health care stakeholders and patients who prefer a once-daily treatment option for long-term stroke prevention in NVAF.


OBJECTIVE
To evaluate the relative cost-effectiveness of two once-daily regimens of novel oral anticoagulation therapy - edoxaban (60 mg/30 mg dose-reduced) versus rivaroxaban (20 mg/15 mg dose-reduced) - for stroke prevention in NVAF patients from a US health-plan perspective.


METHODS
A Markov model simulated lifetime risk and treatment of stroke, systemic embolism, major bleeding, clinically relevant nonmajor bleeding, myocardial infarction, and death in NVAF patients treated with edoxaban or rivaroxaban. Efficacy and safety data were derived from a network meta-analysis that utilized data from patients enrolled in ENGAGE AF-TIMI 48 and ROCKET-AF. Health care cost and utility data were obtained from published sources. Incremental cost-effectiveness ratios of <US$50,000, $50,000-$150,000, and >$150,000 per quality-adjusted life year (QALY) gained were used as thresholds for "highly cost-effective", "cost-effective", and "not cost-effective" treatment options, respectively, as per American Heart Association/American College of Cardiology guidelines.


RESULTS
Edoxaban was dominant relative to rivaroxaban, such that it was associated with lower total health care costs and better effectiveness in terms of QALYs in the base-case analysis. Results were supported by probabilistic sensitivity analyses that showed edoxaban as either dominant or a highly cost-effective alternative (incremental cost-effectiveness ratio <$50,000) to rivaroxaban in 88.4% of 10,000 simulations.


CONCLUSIONS
Results of this study showed that the once-daily edoxaban (60 mg/30 mg dose-reduced) regimen is a cost-saving or highly cost-effective treatment relative to rivaroxaban (20 mg/15 mg dose-reduced) for stroke prevention in NVAF patients with CHADS2 ≥2.
Truven Health Analytics Inc, Cambridge, MA, USA.
Jeffrey D
JD
Miller
Daiichi Sankyo Inc, Parsippany, NJ, USA.
Xin
X
Ye
Truven Health Analytics Inc, Cambridge, MA, USA.
Gregory M
GM
Lenhart
Truven Health Analytics Inc, Cambridge, MA, USA.
Amanda M
AM
Farr
Truven Health Analytics Inc, Cambridge, MA, USA.
Oth V
OV
Tran
Daiichi Sankyo Inc, Parsippany, NJ, USA.
W Jackie
WJ
Kwong
St Luke Mid-America Heart Institute, Kansas City, MO, USA.
Elizabeth A
EA
Magnuson
Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE, USA.
William S
WS
Weintraub
NOAC; SPAF; cost-effectiveness; economic analysis; economic model; edoxaban; nonvalvular atrial fibrillation; oral anti-coagulation; rivaroxaban; stroke