Comparison of differences in medical costs when new oral anticoagulants are used for the treatment of patients with non-valvular atrial fibrillation and venous thromboembolism vs warfarin or placebo in the US

Figures & data

Table 1. Estimated clinical event rates (per patient-year) associated with use of new oral anticoagulants (NOACs) vs warfarin among non-valvular atrial fibrillation patients.

Drug name	Dabigatran-150 mg vs warfarin (% per patient year [CI])	Rivaroxaban vs warfarin (% per patient year [CI])	Apixaban vs warfarin (% per patient year [CI])	Edoxaban 60 mg vs warfarin (% per patient year [CI])
Trial name	RE-LY	ROCKET-AF	ARISTOTLE	ENGAGE-AF
Primary efficacy end-points
Ischemic or uncertain type of stroke	0.91 [0.72, 1.18] vs 1.20 [1.20, 1.20]	1.43 [1.14, 1.78] vs 1.52 [1.52, 1.52]	0.97 [0.78, 1.19] vs 1.05 [1.05, 1.05]	1.25 [1.04, 1.49] vs 1.25 [1.25, 1.25]
Hemorrhagic stroke	0.10 [0.05, 0.19] vs 0.38 [0.38, 0.38]	0.26 [0.16, 0.41] vs 0.44 [0.44, 0.44]	0.24 [0.16, 0.35] vs 0.47 [0.47, 0.47]	0.25 [0.18, 0.36] vs 0.47 [0.47, 0.47]
Systemic embolism	0.08 [0.06, 0.10] vs 0.12 [0.12, 0.12]	0.04 [0.02, 0.12] vs 0.19 [0.19, 0.19]	0.09 [0.04, 0.18] vs 0.10 [0.10, 0.10]	0.08 [0.04, 0.15] vs 0.12 [0.12, 0.12]
Secondary efficacy end-points
Myocardial infarction	0.81 [0.60, 1.09] vs 0.64 [0.64, 0.64]	0.91 [0.71, 1.19] vs 1.12 [1.12, 1.12]	0.54 [0.40, 0.71] vs 0.61 [0.61, 0.61]	0.71 [0.56, 0.89] vs 0.75 [0.75, 0.75]
Pulmonary embolism or deep-vein thrombosis	0.14 [0.07, 0.31] vs 0.09 [0.09, 0.09]	0.04 [0.04, 0.05] vs 0.05 [0.05, 0.05]	0.04 [0.01, 0.11] vs 0.05 [0.05, 0.05]	0.14 [0.08, 0.24] vs 0.14 [0.14, 0.14]
Safety end-points
Major bleedings-excluding hemorrhagic stroke	3.22 [2.84, 3.63] vs 3.19 [3.19, 3.19]	3.28 [2.90, 3.67] vs 2.96 [2.96, 2.96]	1.89 [1.69, 2.12] vs 2.62 [2.62, 2.62]	2.49 [2.26, 2.76] vs 3.43 [3.43, 3.43]
Clinically relevant non-major bleedings	0 vs 0	11.86 [10.94, 12.88] vs 11.40 [11.39, 11.41]	1.99 [1.78, 2.19] vs 2.92 [2.92, 2.92]	8.73 [8.02, 9.44] vs 10.15 [10.14, 10.16]
Other minor bleedings	14.90 [13.91, 15.88] vs 16.37 [16.36, 16.38]	2.35 [1.97, 4.85] vs 2.03 [2.03, 2.03]	14.05 [13.46, 14.84] vs 19.8 [19.8, 19.8]	4.11 [3.72, 4.60] vs 4.89 [4.89, 4.90]

CI, Confidence interval.

Table 2. Differences in medical costs among non-valvular atrial fibrillation (NVAF) patients treated with new oral anticoagulants (NOACs) vs warfarin.

Outcomes	Dabigatran-150 mg vs warfarin ($/patient-year)	Rivaroxaban vs warfarin ($/patient-year)	Apixaban vs warfarin ($/patient-year)	Edoxaban-60 mg vs warfarin ($/patient-year)
Primary efficacy end-points
Ischemic or uncertain type of stroke	−$126	−$40	−$37	$0
Hemorrhagic stroke	−$161	−$104	−$132	−$124
Systemic embolism	−$9	−$32	−$3	−$9
Secondary efficacy end-points
Myocardial infarction	$71	−$88	−$30	−$19
Pulmonary embolism or deep-vein thrombosis	$11	−$1	−$2	$1
Safety end-points
Major bleedings—excluding hemorrhagic stroke	$12	$122	−$280	−$181
Clinically relevant non-major bleedings	$0	$2	−$5	−$8
Other minor bleedings	−$1	$0	−$6	−$1
Total medical cost difference	−$204	−$140	−$495	−$340

Negative cost difference values indicate a cost reduction in comparison to warfarin.

Figure 1. Univariate sensitivity analyses examining the influence of variations in clinical event rates on the medical cost differences per patient associated with new oral anticoagulant (NOAC) use relative to warfarin.

Figure 2. Univariate sensitivity analyses examining the influence of variations in incremental costs of clinical events on the medical cost differences per patient associated with new oral anticoagulant (NOAC) use relative to warfarin.

Figure 3. Distribution of total medical cost differences per patient from 10,000 cycles of Monte Carlo simulations.

Figure 4. Projected medical cost differences in the years 2014–2018 among non-valvular atrial fibrillation (NVAF) patients and patients treated for acute venous thromboembolism (A) and for NVAF patients, VTE patients treated for acute VTE, and VTE patients treated for extended periods (B) of a hypothetical cohort of 1 million insured lives.

Table 3. Medical cost differences among non-valvular atrial fibrillation (NVAF) patients and patients treated for acute venous thromboembolism and for VTE patients treated for extended periods of a hypothetical cohort of 1 million insured lives (2014–2018).

	Year 2014	Year 2015	Year 2016	Year 2017	Year 2018
Non-valvular atrial fibrillation (NVAF) patient population
Dabigatran	−$3,025,075	−$3,085,577	−$3,147,288	−$3,210,234	−$3,274,439
Rivaroxaban	−$2,077,411	−$2,118,959	−$2,161,338	−$2,204,565	−$2,248,656
Apixaban	−$7,325,621	−$7,472,133	−$7,621,576	−$7,774,008	−$7,929,488
Edoxaban	−$5,033,264	−$5,133,930	−$5,236,608	−$5,341,340	−$5,448,167
Venous thromboembolism (VTE) patient population—acute VTE only
Dabigatran	−$656,304	−$669,430	−$682,819	−$696,475	−$710,405
Rivaroxaban	−$2,169,134	−$2,212,516	−$2,256,767	−$2,301,902	−$2,347,940
Apixaban	−$4,131,354	−$4,213,981	−$4,298,261	−$4,384,226	−$4,471,911
Edoxaban	−$1,550,065	−$1,581,066	−$1,612,687	−$1,644,941	−$1,677,840
VTE patient population—Extended VTE treatment only
Dabigatran	−$6,286,174	−$6,411,897	−$6,540,135	−$6,670,938	−$6,804,357
Rivaroxaban	−$6,632,220	−$6,764,865	−$6,900,162	−$7,038,165	−$7,178,929
Apixaban-2.5 mg	−$9,561,024	−$9,752,244	−$9,947,289	−$10,146,235	−$10,349,159
Apixaban-5 mg	−$9,548,002	−$9,738,962	−$9,933,741	−$10,132,416	−$10,335,064
NVAF and acute VTE combined population
Dabigatran	−$3,681,379	−$3,755,007	−$3,830,107	−$3,906,709	−$3,984,843
Rivaroxaban	−$4,246,545	−$4,331,476	−$4,418,105	−$4,506,467	−$4,596,596
Apixaban	−$11,456,975	−$11,686,115	−$11,919,837	−$12,158,234	−$12,401,398
Edoxaban	−$6,583,329	−$6,714,996	−$6,849,296	−$6,986,281	−$7,126,007
NVAF, acute VTE, and extended VTE combined population
Dabigatran	−$9,967,553	−$10,166,904	−$10,370,242	−$10,577,647	−$10,789,200
Rivaroxaban	−$10,878,765	−$11,096,340	−$11,318,267	−$11,544,632	−$11,775,525
Apixaban-2.5 mg	−$21,017,999	−$21,438,359	−$21,867,126	−$22,304,468	−$22,750,558
Apixaban-5 mg	−$21,004,977	−$21,425,077	−$21,853,578	−$22,290,650	−$22,736,463