Cost-effectiveness of Dabigatran and Rivaroxaban Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation

Wang, Ye; Xie, Feng; Kong, Ming; Lee, Lai Heng; Ng, Heng Joo; Ko, Yu

doi:10.1007/s10557-014-6558-1

Cited by 25 publications

(27 citation statements)

References 28 publications

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“…The rationale for this was supported by the data from the pivotal trials of edoxaban (Daiichi Sankyo, data on file, 2013) 21 and rivaroxaban, 30 which showed that their relative efficacy versus warfarin did not differ by CHADS 2 score, so there was no need to stratify the thrombotic event risks by CHADS 2 score ( Table 1 ). Consistent with the approach taken by other published cost-effectiveness analyses, the risk of ischemic stroke, TIA, MI, and bleeding events (including hemorrhagic stroke) in our model increased with age, using factors of 1.40, 33 – 36 1.73, 37 1.30, 31 , 32 , 34 , 38 , 39 and 1.97, 31 , 32 , 34 , 36 , 40 respectively, for each decade increase in age. The distribution of stroke severity was based on data from ENGAGE AF-TIMI 48 (Daiichi Sankyo, data on file, 2013).…”

Section: Methodssupporting

confidence: 84%

Cost-effectiveness of edoxaban versus rivaroxaban for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the US

Miller

Lenhart

et al. 2016

CEOR

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BackgroundUnderstanding the value of new anticoagulation therapies compared with existing therapies is of paramount importance in today’s cost-conscious and efficiency-driven health care environment. Edoxaban and rivaroxaban for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with CHADS2 scores ≥2 have been evaluated in pivotal trials versus warfarin. The relative value of edoxaban versus rivaroxaban would be of interest to health care stakeholders and patients who prefer a once-daily treatment option for long-term stroke prevention in NVAF.ObjectiveTo evaluate the relative cost-effectiveness of two once-daily regimens of novel oral anticoagulation therapy – edoxaban (60 mg/30 mg dose-reduced) versus rivaroxaban (20 mg/15 mg dose-reduced) – for stroke prevention in NVAF patients from a US health-plan perspective.Materials and methodsA Markov model simulated lifetime risk and treatment of stroke, systemic embolism, major bleeding, clinically relevant nonmajor bleeding, myocardial infarction, and death in NVAF patients treated with edoxaban or rivaroxaban. Efficacy and safety data were derived from a network meta-analysis that utilized data from patients enrolled in ENGAGE AF-TIMI 48 and ROCKET-AF. Health care cost and utility data were obtained from published sources. Incremental cost-effectiveness ratios of $150,000 per quality-adjusted life year (QALY) gained were used as thresholds for “highly cost-effective”, “cost-effective”, and “not cost-effective” treatment options, respectively, as per American Heart Association/American College of Cardiology guidelines.ResultsEdoxaban was dominant relative to rivaroxaban, such that it was associated with lower total health care costs and better effectiveness in terms of QALYs in the base-case analysis. Results were supported by probabilistic sensitivity analyses that showed edoxaban as either dominant or a highly cost-effective alternative (incremental cost-effectiveness ratio <$50,000) to rivaroxaban in 88.4% of 10,000 simulations.ConclusionResults of this study showed that the once-daily edoxaban (60 mg/30 mg dose-reduced) regimen is a cost-saving or highly cost-effective treatment relative to rivaroxaban (20 mg/15 mg dose-reduced) for stroke prevention in NVAF patients with CHADS2 ≥2.

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Section: Methodssupporting

confidence: 84%

Cost-effectiveness of edoxaban versus rivaroxaban for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the US

Miller

Lenhart

et al. 2016

CEOR

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“…Moreover, rivaroxaban was consistently reported as a cost-effective alternative to warfarin among AF populations in recent publications [ 15 , 16 , 33 , 35 ]. Rivaroxaban was also shown to be cost-effective compared to warfarin in a Singapore health care setting, which suggests that the cost-effectiveness of rivaroxaban versus warfarin is global [ 36 ]. To be cost-effective means that the new product provides sufficient benefits to justify the added cost.…”

Section: Discussionmentioning

confidence: 99%

Effect of Rivaroxaban Versus Warfarin on Health Care Costs Among Nonvalvular Atrial Fibrillation Patients: Observations from Rivaroxaban Users and Matched Warfarin Users

et al. 2015

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IntroductionNew target-specific oral anticoagulants may have benefits, such as shorter hospital length of stay, compared to warfarin in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to assess, among patients with NVAF, the effect of rivaroxaban versus warfarin on health care costs in a cohort of rivaroxaban users and matched warfarin users.MethodsHealth care claims from the Humana database from 5/2011 to 12/2012 were analyzed. Adult patients newly initiated on rivaroxaban or warfarin with ≥2 atrial fibrillation (AF) diagnoses (The International Classification of Diseases, Ninth Revision, Clinical Modification: 427.31) and without valvular AF were identified. Based on propensity score methods, warfarin patients were matched 1:1 to rivaroxaban patients. Patients were observed up to end of data, end of insurance coverage, death, a switch to another anticoagulant, or treatment nonpersistence. Health care costs [hospitalization, emergency room (ER), outpatient, and pharmacy costs] were evaluated using Lin’s method.ResultsMatches were found for all rivaroxaban patients, and characteristics of the matched groups (n = 2253 per group) were well balanced. Estimated mean all-cause and AF-related hospitalization costs were significantly lower for rivaroxaban versus warfarin patients (all-cause: $5411 vs. $7427, P = 0.047; AF-related: $2872 vs. $4147, P = 0.020). Corresponding estimated mean all-cause outpatient visit costs were also significantly lower, but estimated mean pharmacy costs were significantly higher for rivaroxaban patients ($5316 vs. $2620, P < 0.001). Although estimated mean costs of ER visits were higher for rivaroxaban users compared to those of warfarin users, differences were not statistically significant. Including anticoagulant costs, mean overall total all-cause costs were comparable for rivaroxaban versus warfarin users due to cost offset from a reduction in the number and length of hospitalizations and number of outpatient visits ($17,590 vs. $18,676, P = 0.542).ConclusionDespite higher anticoagulant cost, mean overall total all-cause and AF-related cost remains comparable for patients with NVAF treated with rivaroxaban versus warfarin due to the cost offset from reduced health care resource utilization.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0189-1) contains supplementary material, which is available to authorized users.

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“…The only exception was for the analysis for the Greek setting where the total lifetime cost was found lower for rivaroxaban treatment resulting in a cost saving of e239 17 . The number of QALY was found higher for the rivaroxaban treatment compared to the warfarin treatment [8][9][10][11][12][13][14][15][16][17] . Rivaroxaban treatment was found to be cost-effective compared to the warfarin treatment in those studies [8][9][10][11][12][13][14][15][16][17] .…”

Section: Discussionmentioning

confidence: 89%

“…It also has less drug-drug and drug-food interactions than warfarin. Although previous analyses in other countries indicated that rivaroxaban is more cost-effective compared to warfarin [8][9][10][11][12][13][14][15][16][17] . Clinical practices in Japan such as lower anticoagulation targets, healthcare costs and efficacy and safety of rivaroxaban in the Japanese population are different from other countries.…”

Section: Introductionmentioning

confidence: 93%

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

Hori

Tanahashi

Akiyama

et al. 2019

Journal of Medical Economics

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Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer's perspective. Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis. Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (e1,011.11) per patient (1 JPY ¼ 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2, 873,499 (e24,446.42) per QALY. Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases. Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY. ARTICLE HISTORY

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Cost-effectiveness of Dabigatran and Rivaroxaban Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation

Abstract: Rivaroxaban may be a cost-effective alternative to warfarin for the prevention of stroke in patients with AF in Singapore.

Cited by 25 publications

References 28 publications

Cost-effectiveness of edoxaban versus rivaroxaban for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the US

Cost-effectiveness of edoxaban versus rivaroxaban for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the US

Effect of Rivaroxaban Versus Warfarin on Health Care Costs Among Nonvalvular Atrial Fibrillation Patients: Observations from Rivaroxaban Users and Matched Warfarin Users

Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation in the Japanese healthcare setting

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