Cost-effectiveness analysis of apixaban compared to other direct oral anticoagulants for prevention of stroke in Austrian atrial fibrillation patients

Objectives Several direct oral anticoagulants (DOACs) have been approved by the European Medicines Agency since 2008. The aim of the present cost-effectiveness-analysis was to analyze apixaban compared to other DOACs and vitamin K antagonists (warfarin) in Austria. Methods A cost-utility-model was developed to simulate lifetime-costs and quality-adjusted-life-years of DOACs and warfarin, based on a published Markov-Model and 23 randomized trials with 94,656 atrial-fibrillation (AF) patients. Each year, a patient has a probability of suffering a clinically relevant (extracranial) bleed, an intracranial hemorrhage (ICH), an ischemic stroke or a myocardial infarction (MI), remaining healthy, or deceasing. Direct-costs (2018euro) were derived from published sources from the payer's perspective. Results In the base-case, warfarin had the lowest cost of 12,968 euro (95%-CI +/- 593 euro) followed by apixaban (15,269 euro +/- 661 euro), edoxaban (15,534 euro +/- 641 euro), dabigatran (15,687 euro +/- 667 euro), and rivaroxaban (17,522 euro +/- 764 euro). Apixaban had the highest quality-adjusted-life-years estimate at 5.45 (SD, 0.06). In a Monte-Carlo probabilistic sensitivity analysis, apixaban was cost-effective vs. edoxaban, dabigatran, warfarin, and rivaroxaban in 85.6%, 79.0%, 76.4%, and 61.2% of the simulations, respectively. Conclusion In patients with AF and an increased risk of stroke, prophylaxis with apixaban was highly cost-effective from the perspective of the Austrian health-care system.

Automated summary

The study compared the cost-effectiveness of various oral anticoagulants and warfarin in Austria, with apixaban being highly cost-effective for patients with atrial fibrillation and increased stroke risk in the Austrian healthcare system.