Abstract 18609: Cost-effectiveness of Apixaban Against Dabigatran and Rivaroxaban for Stroke Prevention in Non-valvular Atrial Fibrillation Patients
Purpose: Recent American Heart Association and American Stroke Congress guidelines have recommended the use of new oral anticoagulants (NOACs), including dabigatran, rivaroxaban and apixaban as alternatives to warfarin. We evaluated the potential cost effectiveness of apixaban 5mg BID against dabigatran 150mg BID and rivaroxaban 20mg QD from the perspective of the US health care payer.
Methods: A lifetime Markov model was developed to evaluate the clinical and economic impact of apixaban compared to dabigatran and rivaroxaban from a third-party payer’s perspective. Clinical events captured include ischemic stroke, hemorrhagic stroke, intracranial hemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations. Key input data sources were: clinical data derived from ARISTOTLE and AVERROES; US life tables; published literature focusing on resource use, costs and utilities. National average drug acquisition costs reported to Medicaid were used. Medical costs were estimated in 2013 USD and discounted at 3.0% per year. Outcomes were assessed as number needed to treat to avoid one stroke, number needed to harm with an additional bleed, quality adjusted life years (QALYs) gained and incremental cost effectiveness ratio (ICER).
Results: Lifetime cost-effectiveness of apixaban vs. dabigatran and rivaroxaban at lifetime horizon are described below.
Conclusions: Apixaban was projected to avoid strokes without increasing the risk of major bleeds as compared to dabigatran and rivaroxaban. Apixaban was also projected to increase life expectancy and QALYs in comparison to dabigatran and rivaroxaban at minimal or no additional cost, subsequently offering a cost-effective alternative in comparison to dabigatran and a dominant, i.e. less costly and more effective, alternative in comparison to rivaroxaban.
Author Disclosures: G.Y. Lip: Honoraria; Significant; Has served as a consultant and has been on the speakers bureau for Bayer, Astellas, Merck, Sanofi, BMS/Pfizer, Daiichi- Sankyo, Biotronik, Portola, and Boehringer Ingelheim. T. Lanitis: Consultant/Advisory Board; Significant; Paid consultant to Pfizer/BMS in connection with conducting this study. T. Kongnakorn: Consultant/Advisory Board; Significant; Paid consultant to Pfizer/BMS in connection with conducting this study. H. Phatak: Employment; Significant; Employee of Bristol-Myers Squibb with ownership of stocks. L.Z. Liu: Employment; Significant; Employee of Pfizer inc. with ownership of stocks. J. Lawrence: Employment; Significant; Employee of Bristol-Myers Squibb with ownership of stocks. P. Dorian: Honoraria; Significant; Has received honoraria and research support from BMS, Pfizer, Boehringer Ingelheim, and Bayer. He served on the Steering Committee of the ARISTOTLE trial..
- © 2014 by American Heart Association, Inc.