title: Cost-Effectiveness Analysis of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation in Taiwan.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost effectiveness of novel oral anticoagulants (NOACs) for stroke prevention among atrial fibrillation (AF) patients by incorporating Taiwanese demographic information derived from a population-based database, the National Health Insurance Research Database (NHIRD), into cost-effectiveness analysis.
  
  
  METHODS
  From 1 January to 31 December 2012, 98,213 AF patients were selected from the NHIRD database. A Markov model was constructed that combined published secondary data with the Taiwan NHIRD to compare the cost and incremental cost effectiveness of apixaban 5 mg twice daily, dabigatran 110 or 150 mg twice daily, rivaroxaban 20 mg once daily, and warfarin.
  
  
  RESULTS
  The lifetime costs of warfarin, dabigatran 110 mg, dabigatran 150 mg, rivaroxaban 20 mg, and apixaban 5 mg were US$10,660, US$13,693, US$13,426, US$13,455, US$15,965, respectively. Apixaban resulted in an incremental cost effectiveness of US$39,351, US$27,039, US$41,298, and US$48,896 per quality-adjusted life-year (QALY) compared with warfarin, dabigatran 110 mg, dabigatran 150 mg, and rivaroxaban 20 mg, respectively. In Monte-Carlo analyses, apixaban 5 mg, rivaroxaban 20 mg, warfarin, and dabigatran 110 mg were cost effective in 83, 10.4, 7, and 0.8%, respectively, of the simulations using a willingness-to-pay (WTP) threshold of US$50,000 per QALY.
  
  
  CONCLUSIONS
  Apixaban was more cost effective than warfarin, dabigatran, and rivaroxaban for stroke prevention in patients with AF. Among the anticoagulant therapies, the WTP threshold of apixaban was about US$50,000 per QALY gained. These cost-effectiveness estimations provide useful information to aid clinical decision making in stroke prevention for AF patients.
authors.affiliation: Department of Midwifery and Women Care, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Min-der Road, Bei-tou district, Taipei, Taiwan, ROC. chiehyu@ntunhs.edu.tw.|Department of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Min-der Road, Bei-tou district, Taipei, Taiwan, ROC. chiehyu@ntunhs.edu.tw.
authors.forename: Chieh-Yu
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Min-der Road, Bei-tou district, Taipei, Taiwan, ROC.
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D013624:Taiwan; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran