Elsevier

Thrombosis Research

Volume 134, Issue 2, August 2014, Pages 278-287
Thrombosis Research

Regular Article
Cost-effectiveness of Apixaban versus Warfarin and Aspirin in Sweden for Stroke Prevention in Patients with Atrial Fibrillation

https://doi.org/10.1016/j.thromres.2014.05.027Get rights and content
Under a Creative Commons license
open access

Abstract

Introduction

Atrial fibrillation (AF), one of the major risk factors for stroke, imposing a substantial burden to the Swedish health care system. Apixaban has demonstrated superiority to warfarin and aspirin in stroke prevention amongst patients with AF in two large randomised clinical trials. The aim of this study was to assess the economic implications of apixaban against warfarin and aspirin in these patients from a Swedish societal perspective.

Materials and Methods

A Markov cohort model was constructed to characterise the consequences of anticoagulant treatment with regards to thromboembolic and bleeding events, as well as the associated health care costs, life-years and quality-adjusted life years (QALYs) for patients with AF treated with apixaban, warfarin or aspirin. Incremental cost-effectiveness ratios (ICERs) per QALY gained of apixaban relative to warfarin (among patients suitable for warfarin treatment) and aspirin (among patients unsuitable for warfarin treatment) were calculated. Costs (in 2011 SEKs) and QALYs were discounted at 3% per annum.

Results

The model estimated the ICER of apixaban versus warfarin amongst patients who are suitable for warfarin therapy to be SEK 33,458/QALY gained and that of apixaban versus aspirin amongst those unsuitable for warfarin therapy to be SEK 41,453/QALY gained. Probabilistic sensitivity analyses indicate that apixaban is an optimal treatment option compared with warfarin and aspirin, when the willingness-to-pay is above SEK 35,000 and SEK 45,000 per QALY, respectively.

Conclusions

Apixaban was found to be a cost-effective alternative to warfarin and aspirin for stroke prevention in patients with AF in Sweden.

Abbreviations

AF
Atrial fibrillation
OAC
Oral anticoagulant
INR
International normalised ratio
TTR
Time in therapeutic range
NOAC
Novel oral anticoagulant
ARISTOTLE
Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation
AVERROES
Apixaban versus Acetylsalicylic Acid to Prevent Strokes
HR
Hazard ratio
CI
Confidence interval
NVAF
Non-valvular atrial fibrillation
QALY
Quality-adjusted life year
SE
Systemic embolism
MI
Myocardial infarction
ICH
Intracranial haemorrhage
CRNM
Clinically relevant non-major
CV
Cardiovascular
SEK
Swedish kronor
GI
Gastrointestinal
EQ-5D
EuroQol 5 dimensions
ICER
Incremental cost-effectiveness ratio
cTTR
Centre time in therapeutic range
CEAC
Cost-effectiveness acceptability curve

Keywords

Apixaban
Atrial fibrillation
Warfarin
Aspirin
Cost-effectiveness

Cited by (0)

1

Tel.:+ 66 2 573 1467.

2

Tel.: + 46 70 347 58 77.

3

Tel.: + 46 8 550 524 30.