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

ABSTRACT

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 (2018€) were derived from published sources from the payer’s perspective.

Results

In the base-case, warfarin had the lowest cost of 12,968 € (95%-CI±593 €) followed by apixaban (15,269 €±661 €), edoxaban (15,534 €±641 €), dabigatran (15,687 €±667 €), and rivaroxaban (17,522 €±764 €). 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.

KEYWORDS:

• Cost-effectiveness
• cost-utility
• apixaban
• atrial fibrillation
• stroke prevention

Acknowledgments

All figures and tables were produced by EW except for Figure 1 which was derived from figure A2.2 (Illustration of the Markov model). Figure A2.2 was originally published in the appendix of López-López et al. (2017) [13]. The permission to use this figure in the present article is granted by the authors of López-López et al. (2017). The permission relates to the derived Figure 1 in the present study.

Author contributions

EW has substantially contributed to the concept of the study, to the analysis and modelling and interpretation of the data, drafted the article, revised the article and finally approved the version to be published. MV and GE gathered and interpreted the data and drafted the article.

Declaration of interest

EW has previously received lecture fees from Bristol-Myers Squibb GmbH, Austria.

MV and GE have no conflict of interest regarding the subject matter or materials discussed in the present paper. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was sponsored by the Bristol-Myers Squibb-Pfizer Alliance.