Is Apixaban Therapy More Cost-Effective Than Warfarin?

Apixaban therapy for atrial fibrillation (AFib) patients provides clinical benefits and is more cost-effective for U.S. patients based on incremental cost per quality-adjusted life-year gained as compared to warfarin therapy, according to a study published March 29 in JAMA Cardiology.

The study, by Patricia A. Cowper, PhD, et al., used patient-level data from the ARISTOTLE trial to compare life expectancies of patients being treated with warfarin therapy vs. apixaban therapy and looked at quality-of-life adjustment factors. In the trial, 18,201 patients with AFib and one or more risk factors for stroke were randomized to apixaban therapy or warfarin therapy in 39 countries between 2006 and 2010.

Results showed that after two years of anticoagulation therapy, health care costs (excluding the study drug) of patients treated with apixaban therapy and warfarin therapy were not statistically different. Life expectancy was significantly longer with apixaban therapy vs. warfarin therapy – 7.94 vs. 7.54 quality-adjusted life years.

The incremental cost, including the costs of anticoagulant and monitoring, was “within accepted U.S. norms” ($58,925 per quality-adjusted life year, with 98 percent likelihood of meeting a $100,000 willingness-to-pay threshold).

“Our analysis suggests that anticoagulation therapy for patients with AFib using apixaban rather than warfarin increases average quality-adjusted life expectancy at an additional cost that falls within current U.S. norms for reasonable value in health care,” the authors explain. “This result stems primarily from gains in life-years accumulated over a lifetime of therapy, as we did not find convincing evidence of a meaningful reduction in health care costs to offset the additional ongoing cost of apixaban therapy.”

In a related commentary, Mark A. Hlatky, MD, FACC, notes that “the fundamental principle of cost-effectiveness analysis is that higher costs of a new therapy may be acceptable if clinical outcomes are improved enough.” Although the increased life expectancy of 0.4 years (five months) with apixaban therapy may seem short, Hlatky explains that it is quite significant. “Another way to interpret this number is that it equals the effect of having one more patient survive out of every 19 patients treated, with an average life expectancy of 7.54 years.” Hlatky concludes that “the clinical outcomes were improved sufficiently to provide reasonable value in the setting of the U.S. system.” 

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Accidental Falls, Anticoagulants, Atrial Fibrillation, Cost-Benefit Analysis, Health Care Costs, Life Expectancy, Pyrazoles, Pyridones, Quality-Adjusted Life Years, Risk Factors, Stroke, Warfarin

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