Cost-Effectiveness of Rivaroxaban Versus Warfarin for Stroke Prevention in Atrial Fibrillation in the Belgian Healthcare Setting

Abstract

BackgroundWarfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines.ObjectiveThe aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk.MethodsA Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature.ResultsRivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.ConclusionsThe present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-013-0087-9) contains supplementary material, which is available to authorized users.

Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation

“…Although there were substantial differences in the model structure and usage of utilities, their results are similar to those of our analysis (ICER ranging from dominance to €20,089 per QALY) [16][17][18][19][20].…”

“…Whereas European studies yielded an incremental cost-effectiveness ratio (ICER) ranging from dominance to €20,089 per quality-adjusted life-year (QALY) [16][17][18][19][20], the ICERs of studies conducted in the US or Canada ranged from $3,200 to $55,800 per QALY [21][22][23]. However, to date, no study has evaluated the cost effectiveness of rivaroxaban compared with conventional warfarin for the German healthcare system.…”

Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin

“…This avoids the situation of an intervention being compared with a treatment option that is not cost effective and, thereby, misguiding healthcare providers to make non-efficient decisions of limited resources. Whilst all four NOACs were found to be cost effective in comparison to warfarin (consistent with earlier findings [20,24]), the incremental analysis highlighted that dabigatran 150 mg dominated dabigatran 110 mg and apixaban extendedly dominated both dabigatran 150 mg and rivaroxaban, although differences are small. Thus, the deterministic analysis would suggest that from available OACs on the Belgian market, apixaban and warfarin represent the ''best that the system can do with available agents at current prices'' [25].…”

“…Amongst those, two studies have compared an individual NOAC with VKA treatment from a Belgian perspective [20,24]. Simultaneous assessment of the efficiency of the new interventions (i.e.…”

A cost comparison of warfarin vs enoxaparine or new oral anticoagulants used for the treatment of patients with pulmonary embolism

“…In a study by Beckman et al, PE monotherapy with enoxaparine was shown to cause a 2-day decrease in the median LOS compared with the standard regimen (10). In a study in which Markov modeling was constructed based on the EINSTEIN-PE study, Lefebvre et al (11) showed that rivaroxaban therapy costs $2.448 per Even though there has been no published study about the diagnosis and treatment costs of PE in our country, studies comparing these three pharmaceuticals for deep-vein thrombosis, PE, stroke, nonvalvular atrial fibrillation treatment, and orthopedic postoperative prophylaxis demonstrated that new oral anticoagulants were more costeffective than warfarin and enoxaparine (11)(12)(13)(14)(15)(16). However, it should be remembered that costs related to hospitalization and complications are also included in these studies.…”