Arrhythmias and conduction disturbancesCost–Effectiveness of Rivaroxaban Compared to Warfarin for Stroke Prevention in Atrial Fibrillation
Section snippets
Methods
We developed a Markov cohort model to evaluate the cost–effectiveness of rivaroxaban 20 mg 1 times/day (15 mg/day in patients with creatinine clearances from 15 to 50 mL/min) compared to adjusted-dose warfarin in patients with AF (Figure 1). Base-case analysis consisted of a cohort of patients with AF 65 years old at high-risk for stroke (congestive heart failure, hypertension, age, diabetes, stroke [CHADS2] score of 3) and no contraindications to anticoagulation. Health states modeled included
Results
Under base-case assumptions, patients with AF treated with adjusted-dose warfarin lived an average of 9.812 QALYs, incurring average lifetime treatments costs of $88,544. Those treated with rivaroxaban lived an average of 10.027 QALYs, with an average lifetime cost of $94,456. Thus, the ICER for rivaroxaban was $27,498 per QALY.
At the lowest range of rivaroxaban drug cost, $123, rivaroxaban became an economically dominant strategy (Figure 2). Conversely, when using the highest range of
Discussion
Our Markov model demonstrates rivaroxaban may be a cost–effective alternative to warfarin in patients with AF regardless of baseline ischemic stroke risk. Patients on rivaroxaban gained an additional 0.215 QALYs over a lifetime but at an additional cost of $5,912, resulting in an ICER of $27,498 per QALY. The cost–effectiveness of rivaroxaban was found to be sensitive to HRs for stroke and ICH, cost of rivaroxaban, utility of being on the drug, monthly cost of ICH, and time horizon of the
References (30)
- et al.
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trialsStudies of Left Ventricular Dysfunction
J Am Coll Cardiol
(1998) - et al.
Decision analysis and guidelines for anticoagulant therapy to prevent stroke in patients with atrial fibrillation
Lancet
(2000) - et al.
Long-term economic outcomes associated with intensive versus moderate lipid-lowering therapy in coronary artery disease: results from the Treating to New Targets (TNT) trial
Am Heart J
(2008) - et al.
Cost–effectiveness of pravastatin therapy for survivors of myocardial infarction with average cholesterol levels
Am Heart J
(2001) - et al.
Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA)
J Thromb Haemost
(2010) - et al.
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation
N Engl J Med
(2011) - et al.
Validation of clinical classification schemes for predicting stroke: results from the National Registry Of Atrial Fibrillation
JAMA
(2001) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillationAnalysis of pooled data from five randomized controlled trials
Arch Intern Med
(1994)- et al.
Risk factors for intracranial hemorrhage in outpatients taking warfarin
Ann Intern Med
(1994) - et al.
Risk factors for intracerebral hemorrhage in the general population: a systematic review
Stroke
(2003)
Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission
Circ Cardiovasc Qual Outcomes
2003 Nationwide Inpatient Sample
Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project
Stroke
The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life
Arch Intern Med
Preference-based EQ-5D index scores for chronic conditions in the United States
Med Decis Making
Cited by (118)
Cost effectiveness of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients in Saudi Arabia: A Single–Center retrospective cohort study
2023, Saudi Pharmaceutical JournalCitation Excerpt :In this study rivaroxaban has shown to be equally effective in reducing the rates of hospitalization and mortality in comparison to warfarin when used for thrombosis prophylaxis among nonvalvular AF patients. These findings are unsurprising and consistent with other previously published studies that have proven rivaroxaban to be at least as effective as warfarin among nonvalvular AF patients with respect to preventing stroke, MI, hospitalization, and all-cause mortality (Bowrin et al., 2020; Hua et al., 2021; Jaberi et al., 2021; Lee et al., 2012; Wei et al., 2021). Moreover, rivaroxaban was found to be cost saving in all of the bootstrap simulations, and dominant in more than 87 % of the simulations mainly because it does not require frequent lab monitoring.
Cost-effectiveness of rivaroxaban versus warfarin for treatment of nonvalvular atrial fibrillation in patients with worsening renal function
2019, International Journal of CardiologyCitation Excerpt :Lee et al. [13] utilized a Markov model to assess the cost-effectiveness of rivaroxaban compared to adjusted-dose warfarin for the prevention of stroke in patients with AF from a Medicare perspective. In 10,000 Monte Carlo simulations, rivaroxaban was shown to be cost-effective 80% and 91% of the time with willingness to pay thresholds of $50,000 and $100,000 per QALY, respectively [13]. Harrington et al. [14] used a Markov model from a societal perspective to study cost/QALY gains of NOACs including rivaroxaban over warfarin, finding that rivaroxaban would be highly cost-effective at any reasonable threshold with an incremental cost-effectiveness ratio (ICER) of $3190/QALY [14].
An Economic Analysis of Stroke and Atrial Fibrillation
2018, Stroke Prevention in Atrial FibrillationCost-effectiveness of endovascular therapy for acute ischemic stroke with large infarct in China
2023, Journal of NeuroInterventional Surgery
Dr. Coleman has received research funding from Janssen Pharmaceuticals, Inc., and is a member of their speaker's bureau. Dr. Kluger is a member of Janssen Pharmaceuticals, Inc. (Titusville, New Jersey), speakers' bureau.