Comparing the Cost Effectiveness of Non-vitamin K Antagonist Oral Anticoagulants with Well-Managed Warfarin for Stroke Prevention in Atrial Fibrillation Patients at High Risk of Bleeding

Abstract

The comparative cost effectiveness of edoxaban and warfarin is highly sensitive to TTR. At the $US100,000/QALY willingness-to-pay threshold, our results suggest that warfarin is the most cost-effective treatment for patients who can achieve a TTR of 70%.

Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review

“…Only one study [ 10 ] evaluated the cost effectiveness of rate control strategies in AF management in HIC. Of the 32 studies that evaluated strategies for stroke prevention in HIC, 14 were from North America [ 8 , 25 , 26 , 28 , 29 , 31 , 32 , 37 – 39 , 44 , 46 – 48 ], 13 from Europe [ 18 , 19 , 22 – 24 , 27 , 30 , 33 – 35 , 40 , 42 , 45 ], 4 from Asia [ 21 , 29 , 43 , 47 ] and 1 from Oceania [ 28 ]. The proportion of male sex (52–77%) was higher than the female sex in most of the studies.…”

“…The willingness-to-pay threshold also varied across the studies. Studies from the USA used a threshold of either $50,000 [ 25 , 28 , 38 , 39 , 46 , 47 ] or $100,000 [ 8 , 19 , 26 , 39 , 58 ] per QALY gained. Studies from the UK used the National Institute of Health and Clinical Excellence (NICE) recommended threshold between £20,000 and £30,000 per QALY [ 40 , 60 , 62 ].…”

“…In those at moderate risk of stroke, apixaban was the optimal strategy in 11 of 18 included studies [ 8 , 18 , 26 , 27 , 29 , 35 , 37 , 41 , 43 , 45 , 47 ]. These studies either compared warfarin with DOACs or compared between DOACs, but 1 of the 11 studies compared LAAC with warfarin and DOACs [ 34 ].…”

“…Two studies provided evidence that apixaban was the optimal studies, but LAAC was not a comparator in any of the two studies [ 32 , 37 ]. PG-warfarin and PG-DOAC were the cost-effective choice in two different studies, but were not compared with LAAC [ 26 , 46 ] (see Table 2 ).…”

Cost-effectiveness of Direct Oral Anticoagulant vs. Warfarin Among Atrial Fibrillation Patients With Intermediate Stroke Risk

“…Third, in this study, the patients who had switched to the counter group had been excluded. The cost-effectiveness of warfarin depends on the time in therapeutic range (TTR), which was not evaluated in the present study ( 35 ). Warfarin users with poor TTR maintenance or minor bleeding episodes which were not included in clinical outcome, might underestimate cost of warfarin group.…”