Cost-Effectiveness of Apixaban vs. Current Standard of Care for Stroke Prevention in Patients With Atrial Fibrillation

Study Questions:

What is the potential cost-effectiveness of apixaban against warfarin and aspirin for stroke prevention in patients with atrial fibrillation (AF) from the UK payer perspective?


A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in vitamin K antagonist (VKA)-suitable and VKA-unsuitable patients, respectively. Clinical events considered in the model included ischemic stroke, hemorrhagic stroke, intracranial hemorrhage, other major bleed, clinically relevant nonmajor bleed, myocardial infarction, cardiovascular hospitalization, and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model.


Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over a lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs.


The authors concluded that based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA-suitable and VKA-unsuitable patients with AF, respectively.


This study estimated an incremental cost-effectiveness ratio of £11 909 and £7 196 per QALY gained with apixaban as a first-line treatment in the prevention of stroke and systemic embolism for patients with AF, compared with warfarin and aspirin, respectively. These values are within the range considered to be cost-effective. Fewer thromboembolic events with apixaban translated into life expectancy and QALYs gained and a reduced number of clinical events led to lower medical care costs. Overall, this analysis suggests that apixaban, when compared with the current standard of care, provides a cost-effective alternative for prevention of thromboembolic events in patients with AF.

Clinical Topics: Anticoagulation Management

Keywords: Vitamin K, Myocardial Infarction, Stroke, Life Expectancy, Warfarin, Standard of Care, Pyrazoles, Health Care Costs, Intracranial Hemorrhages, Embolism, Pyridones, Quality-Adjusted Life Years

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