title: Modelling projections for the uptake of edoxaban in an European population to 2050: effects on stroke, thromboembolism, and health economics perspectives.
abstract: In the coming decades, the number of Europeans with atrial fibrillation (AF) is set to rise as the population ages, and so with it will the number of strokes. The risk of thromboembolism (principally stroke and systemic embolism) and death can be reduced by the use of the vitamin K antagonists (VKA, e.g. warfarin) and more so by non-VKA oral anticoagulants (NOACs) such as edoxaban.
  
  
  
  We modelled the effect of the increasing use of edoxaban in preference to warfarin in a European AF population from both clinical and economic perspectives. We estimate that the introduction of NOACs in 2010 eliminated over 88 000 thromboembolisms and deaths annually, of which over 17 000 were ischaemic strokes. At a 1-year cost of €30k per ischaemic stroke, this strategy saved €510 million annually. Should the use of edoxaban increase from 11% in 2013 to 75% by 2030, we expect that rate of thromboembolism and death will fall from 5.67 to 5.42 total events per million patients per year, which will further eliminate over 12 000 of these events annually. At an inflation-adjusted 1-year cost of approximately €35k per ischaemic stroke, this will save €44.5 million each year. At a conservative rate of increase in the AF population of 2.2-fold from 2005, in 2050 there will be around 180 000 AF-related ischaemic strokes that, at an inflation-adjusted cost of around €62k per stroke, sums to €11 116 million. Should the rate of AF rise 2.6-fold from 2005, then in 2050 there will be 214 500 ischaemic strokes that will cost around €13 300 million.
  
  
  
  Our data point to a substantial increase in the human and economic cost burden of AF and so emphasize the need to reduce this burden. This may be achieved by the increased use of oral anticoagulants, particularly with the NOACs such as edoxaban.
authors.affiliation: University of Birmingham Institute for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Blann
authors.affiliation: Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: University of Birmingham Institute for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK g.y.h.lip@bham.ac.uk.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000284:Administration, Oral; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000639:trends; D005060:Europe / Q000453:epidemiology; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D005544:Forecasting; D006801:Humans; D018803:Models, Economic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000639:trends; D011725:Pyridines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D013844:Thiazoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D013923:Thromboembolism / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D065427:Factor Xa Inhibitors; D011725:Pyridines; D013844:Thiazoles; D014859:Warfarin; C552171:edoxaban
keywords: Atrial fibrillation; Edoxaban; Europe; Oral anti-coagulation; Warfarin