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Novel oral anticoagulants more cost effective than warfarin
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Novel oral anticoagulants such as apixaban, dabigatran and rivaroxaban are cost-effective alternatives to warfarin for the prevention of stroke in patients with nonvalvular atrial fibrillation, according to study results in Stroke.
Researchers constructed a Markov decision-analysis model using data from clinical trials to evaluate lifetime costs and quality-adjusted life-years (QALY) of oral anticoagulants compared with warfarin. The population included a hypothetical cohort of 70-year-old patients with nonvalvular AF, increased risk for stroke (CHADS2≥1), renal creatinine clearance ≥50 mL/min, and no previous contraindications to anticoagulants. A threshold of $50,000 willing-to-pay per QALY gained was established.
Apixaban 5 mg (Eliquis, Bristol-Myers Squibb) was the most cost-effective anticoagulant with an estimated QALY gain of 8.47, followed by dabigatran 150 mg (8.41; Pradaxa, Boehringer Ingelheim), rivaroxaban 20 mg (8.26; Xarelto, Janssen Pharmaceuticals) and warfarin (7.97).
Amanda R. Harrington
Warfarin had the lowest estimated lifetime costs of treatment ($77,813), followed by rivaroxaban ($78,738), dabigatran ($82,719) and apixaban ($85,326).
Using a Monte Carlo probabilistic sensitivity analysis, researchers found that apixaban, dabigatran, rivaroxaban and warfarin were cost effective in 45.1%, 40%, 14.9% and 0% of the simulations, respectively.
“Of the three [novel oral anticoagulants], apixaban 5 mg was the preferred anticoagulant for this population because it was most likely to be the cost-effective treatment option at all [willingness-to-pay thresholds] >$40,000 per QALY gained,” Amanda R. Harrington, MD, of the department of pharmacy practice and science at the University of Arizona, and colleagues wrote. “As additional data emerge from studies evaluating the efficacy in subgroups, side effect profile and generalizability of [novel oral anticoagulants], future analyses will perform a more inclusive evaluation of the cost-effectiveness of [novel oral anticoagulants].”
Disclosure: The researchers report no relevant financial disclosures.
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