Cost- e ffectiveness of n on- v itamin K a ntagonist o ral a nticoagulants for s troke p revention in p atients with a trial f ibrillation at h igh r isk of b leeding and n ormal k idney f unction

• Published in: Thrombosis research 2016
• Main Authors: Hernandez, Inmaculada, PharmD, PhD, Smith, Kenneth J., MD, MS, Zhang, Yuting, PhD
• Format: Article
• Language: English
• Subjects: Hematology, Oncology and Palliative Medicine
• ISSN: 0049-3848
• DOI: 10.1016/j.thromres.2016.10.006

Abstract Introduction The comparative cost-effectiveness of all oral anticoagulants approved up to date has not been evaluated from the US perspective. The objective of this study was to compare the cost-effectiveness of edoxaban 60 mg, apixaban 5 mg, dabigatran 150 mg, dabigatran 110 mg, rivaroxaban 20 mg and warfarin in stroke prevention in atrial fibrillation patients at high-risk of bleeding (defined as HAS-BLED score ≥ 3). Materials and m ethods We constructed a Markov state-transition model to evaluate lifetime costs and quality-adjusted life years (QALYs) with each of the six treatments from the perspective of US third-party payers. Probabilities of clinical events were obtained from the RE-LY, ROCKET-AF, ARISTOTLE and ENGAGE AF-TIMI trials; costs were derived from the Healthcare Cost and Utilization Project, and other studies. Because edoxaban is only indicated in patients with creatinine clearance ≤ 95 ml/min, we re-ran our analyses after excluding edoxaban from the analysis. Results Treatment with edoxaban 60 mg cost $77,565/QALY gained compared to warfarin, and apixaban 5 mg cost $108,631/QALY gained compared to edoxaban 60 mg. When edoxaban was not included in the analysis, treatment with apixaban 5 mg cost $84,128/QALY gained, compared to warfarin. Dabigatran 150 mg, dabigatran 110 mg and rivaroxaban 20 mg were dominated strategies. Conclusions For patients with creatinine clearance between 50 and 95 ml/min, apixaban 5 mg was the most cost-effective treatment for willingness-to-pay thresholds (WTP) above $115,000/QALY gained, and edoxaban 60 mg was cost-effective when the WTP was between $75,000 and $115,000/QALY gained. For patients with creatinine clearance > 95 ml/min, apixaban 5 mg was the most cost-effective treatment for WTP thresholds above $80,000/QALY gained.