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Abstract
Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer’s perspective.
Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis.
Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (€1,011.11) per patient (1 JPY = 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 (€24,446.42) per QALY.
Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases.
Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY.
Transparency
MH, NT and RG are paid consultants to Bayer Yakuhin, Ltd. for this study and outside of the study. MH has received remuneration for attending meetings (presentations) from Nippon Boehringer Ingelheim Co., Ltd. and Bayer Yakuhin, Ltd. outside of the study. NT has received remuneration for attending meetings (presentations) from Nippon Boehringer Ingelheim Co., Ltd., Bayer Yakuhin, Ltd., Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, outside of the study. GK and JD are employees of Creativ-Ceutical, a health care consulting firm contracted by Bayer Yakuhin, Ltd. SA as an employee of Bayer Yakuhin, Ltd.
The peer reviewers on this manuscript have received an honorarium from JME for their review work. In addition, a reviewer on this manuscript has disclosed that they have received grant funding from all major producers of NOACs. The reviewers have no other relevant financial relationships or otherwise to disclose.
Author contributions
GK and JD contributed to the literature search and analysis. All authors contributed to the study design, interpretation of data, critical revision of the intellectual content and final approval of the version to be published, and all authors agree to be accountable for all aspects of the work.
Acknowledgements
The authors would like to thank Emi Watanabe Fujinuma for project management support. The authors acknowledge that medical writing support was provided by Małgorzata Biernikiewicz of Creativ-Ceutical, with funding from Bayer Yakuhin, Ltd.