Long-term health benefits of stroke prevention with apixaban versus vitamin K antagonist warfarin in patients with non-valvular atrial fibrillation in Germany: a population-based modelling study

ABSTRACT

Background: Patients with non-valvular atrial fibrillation (NVAF) have a five times higher stroke risk. For more than 50 years, vitamin K antagonists (VKAs) have been the primary medication for stroke prevention. Apixaban, a non-vitamin K oral anticoagulant (NOAC), has demonstrated better efficacy and safety characteristics than the VKA warfarin in the ARISTOTLE trial. This study aims to quantify the potential societal effects of using apixaban instead of VKA in the German NVAF population from 2017 to 2030.

Methods: Using an existing Markov model and a dynamic population approach, we modelled the health benefits of apixaban in patients with NVAF compared to VKA therapy in the German population from 2017 to 2030.

Results: The results represent the extrapolated direct long-term health benefits of apixaban over VKA therapy for the German NVAF population. From 2017 until 2030, the use of apixaban instead of a VKA could avoid 52,185 major clinical events. This includes 15,383 non-fatal strokes or SEs, 22,483 non-fatal major bleeds, and 14,319 all-cause deaths, which correspond to 109,887 life years gained.

Conclusion: This study demonstrated that using apixaban instead of VKA for stroke prevention can lead to considerable reduction in cardiovascular events.

KEYWORDS:

• Non-valvular atrial fibrillation
• non-vitamin K antagonist
• oral anticoagulants
• stroke prevention

Author Contributions

Sebastian Himmler and Malina Mueller contributed equally to the study design, data analysis and interpretation, to the manuscript writing and to final manuscript review. Dennis Ostwald contributed to the study design and revising it critically for intellectual content. Ahmed Seddik was involved in revising it critically for intellectual content. Eva Hradetzky and Edin Basic have supervised data collection and statistical analyses and participated in drafting the article, revising it critically and for intellectual content. All authors read and approved the final manuscript.

Declaration of Interest

S Himmler, M Müller, A Seddik, are employees of WifOR, an independent economic research institute in Darmstadt. D Ostwald is the CEO and founder of WifOR. Dr. Hradetzky and Dr. Basic are employees of Pfizer. 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.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was sponsored by Bristol-Myers Squibb and Pfizer.