Abstract 16534: Cost-Effectiveness of Edoxaban vs. Warfarin in Patients With Atrial Fibrillation: Results From the ENGAGE AF - TIMI 48 Economic Study
Background: The ENGAGE AF-TIMI 48 trial demonstrated that both high dose (HD, 60 mg) and low dose (LD, 30 mg) once-daily regimens of edoxaban (E) were non-inferior to warfarin (W) for the prevention of stroke or systemic embolism (SE) in 21,105 patients with atrial fibrillation (AF), with significantly lower rates of bleeding and cardiovascular death. This study evaluated the economic value of E vs. W.
Method: We assessed the cost-effectiveness of HD and LD E vs. W in US$ over the lifetime of AF patients using a Markov model based on data from the ENGAGE AF-TIMI 48 trial, US life-tables, and published literature on costs and long-term outcomes of non-fatal events in AF patients. ENGAGE AF-TIMI 48 trial data were used to derive age-adjusted event rates for W and hazard ratios for the relative impact of HD and LD E vs. W on embolic and bleeding complications. 2013 wholesale acquisition costs were used for W ($11/month) and E ($269.18/month, assumed as mean cost of marketed novel oral anticoagulants). Incremental cost-effectiveness ratio (ICER) thresholds of <$50K, $50-$150K and >$150K per QALY gained proposed by AHA/ACC were used to differentiate between high, intermediate, and low value treatment options. Probabilistic sensitivity analyses evaluated the impact of model parameter uncertainty on ICERs.
Results: For HD E vs. W, lifetime costs were $42,846 vs. $27,094, and QALYs were 7.249 vs. 6.910, respectively, yielding an ICER of $46,393/QALY gained. The ICER for LD E vs. W was $67,320/QALY. ICERS were lower for patients with no prior W use. For HD E, ICERs differed minimally by CHADS2 score; for LD E ICER was considerably higher for the CHADS2 4-6 subgroup due to increased risk of ischemic stroke with LD E. (Table).
Conclusion: Despite higher acquisition costs, these results suggest that HD E is a high economic value therapeutic alternative relative to W for the prevention of stroke and SE in patients with AF. Low dose E is likely to offer intermediate value from an economic perspective.
Author Disclosures: E.A. Magnuson: Research Grant; Significant; Astra Zeneca, Daiichi Sankyo, Eli Lilly, Edwards Lifesciences, Medtronic. K. Vilain: None. K. Wang: None. H. Li: None. W.J. Kwong: Employment; Significant; Daiichi Sankyo. E.M. Antman: None. C.T. Ruff: Consultant/Advisory Board; Modest; Daiichi Sankyo, Bristol-Myers Squibb, Boehringer Ingelheim. R.P. Guigliano: Research Grant; Significant; Daiichi Sankyo, Merck, Johnson & Johnson, Sanofi Aventis, Astra Zeneca. Speakers Bureau; Modest; Bristol-Myers Squibb, Daiichi Sankyo, Merck, Sanofi Aventis. Consultant/Advisory Board; Modest; Daiichi Sankyo, Janssen Pharmaceuticals, Merck. D.J. Cohen: Speakers Bureau; Modest; Astra Zeneca, Eli Lily. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly, Medtronic, Abbott Vascular. Research Grant; Significant; Medtronic, Edwards Lifesciences, Abbott Vascular, Boston Scientific, Eli Lilly, Daiichi Sankyo, Astra Zeneca, Merck, Biomet, Cardiovascular Systems, Inc..
- © 2014 by American Heart Association, Inc.