The new oral anticoagulants apixaban, dabigatran, and rivaroxaban are cost-effective alternatives to warfarin for stroke prevention in patients with non-valvular atrial fibrillation (AFib), according to a study published in Stroke.

The study used published data from clinical trials to evaluate lifetime costs and quality-adjusted life-years by constructing a Markov decision-analysis model. Results showed that in the base case, warfarin had the lowest cost of $77,813 (SD, $2223), followed by rivaroxaban 20 mg ($78,738±$1852), dabigatran 150 mg ($82,719±$1959), and apixaban 5 mg ($85,326±$1512). In addition, apixaban 5 mg had the highest quality-adjusted life-years estimate at 8.47 (SD, 0.06), followed by dabigatran 150 mg (8.41±0.07), rivaroxaban 20 mg (8.26±0.06), and warfarin (7.97±0.04). The authors note that in a "Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost-effective in 45.1 percent, 40 percent, 14.9 percent, and 0 percent of the simulations, respectively."

Further, compared with warfarin, apixaban 5 mg provided an additional 0.5 quality-adjusted life-years at a cost of $7,513, resulting in an incremental cost-effectiveness ratio of $15,026 per quality-adjusted life-years gained, well below the threshold of $50,000 per quality-adjusted life-years gained.

"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," the authors conclude. Moving forward, the authors note that the results of this study, "in combination with results of previously conducted analyses, provide an estimation of the implications of clinician decisions."

Keywords: Stroke, Morpholines, Benzimidazoles, Warfarin, Pyrazoles, Pyridones