Cost-Effectiveness of Rivaroxaban Compared to Warfarin for Stroke Prevention in Atrial Fibrillation

Study Questions:

Is rivaroxaban more cost-effective than warfarin in patients with atrial fibrillation (AF)?

Methods:

A Markov model was used to estimate the cost-effectiveness of rivaroxaban and warfarin in a hypothetical cohort of 65-year-old patients with AF and three risk factors for stroke (CHADS2 score = 3). Probabilities of major events were based on published clinical trials. A time horizon of 35 years was used. The total AF treatment costs were expressed in 2011 dollars.

Results:

Rivaroxaban was associated with a mean of 10.0 quality-adjusted life years (QALYs) at a total cost of $94,456. Warfarin was associated with a mean of 9.8 QALYs at a total cost of $88,544. The incremental cost-effectiveness ratio (ICER) for rivaroxaban was $27,498/QALY.

Conclusions:

The authors concluded that compared to warfarin, rivaroxaban is cost-effective for stroke prevention in patients with AF.

Perspective:

Although warfarin is much less expensive than rivaroxaban (even when taking the costs of monitoring into account), and despite the fact that rivaroxaban was not found to be superior to warfarin for preventing ischemic strokes, rivaroxaban appears to be cost-effective compared to warfarin. This is largely attributable to a lower risk of intracranial hemorrhage with rivaroxaban than warfarin.

Clinical Topics: Anticoagulation Management

Keywords: Stroke, Intracranial Hemorrhages, Morpholines, Cardiology, Thiophenes, Warfarin, Health Care Costs, Risk Factors, Quality-Adjusted Life Years


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