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Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation

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  • Soyon Lee
  • Rachel Mullin
  • Jon Blazawski
  • Craig I Coleman

Abstract

Background: Apixaban was shown to be superior to adjusted-dose warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation (AF) and at least one additional risk factor for stroke, and associated with reduced rates of hemorrhage. We sought to determine the cost-effectiveness of using apixaban for stroke prevention. Methods: Based on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE) trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS2 score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs), life years saved and incremental cost-effectiveness ratios. Results: Under base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY. Conclusions: In patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin.

Suggested Citation

  • Soyon Lee & Rachel Mullin & Jon Blazawski & Craig I Coleman, 2012. "Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-9, October.
    • Handle: RePEc:plo:pone00:0047473
    DOI: 10.1371/journal.pone.0047473
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    References listed on IDEAS

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    1. Patrick W. Sullivan & Vahram Ghushchyan, 2006. "Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States," Medical Decision Making, , vol. 26(4), pages 410-420, July.
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    1. Xue Li & Vicki C Tse & Wallis C Y Lau & Bernard M Y Cheung & Gregory Y H Lip & Ian C K Wong & Esther W Chan, 2016. "Cost-Effectiveness of Apixaban versus Warfarin in Chinese Patients with Non-Valvular Atrial Fibrillation: A Real-Life and Modelling Analyses," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    2. Brendan L Limone & William L Baker & Jeffrey Kluger & Craig I Coleman, 2013. "Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Systematic Review of Cost-Effectiveness Models," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-15, April.
    3. Jelena Stevanović & Marjolein Pompen & Hoa H Le & Mark H Rozenbaum & Robert G Tieleman & Maarten J Postma, 2014. "Economic Evaluation of Apixaban for the Prevention of Stroke in Non-Valvular Atrial Fibrillation in the Netherlands," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-11, August.

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