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

Abstract

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

The Study of Cost-Effectiveness of Rivaroxaban versus Warfarin in Patients with Atrial Fibrillation Who Developed Ischemic Stroke

“…A study carried out by Craig et al (2013) in the United States to compare the effectiveness and utility revealed that alteration of the treatment method and replacement of warfarin with rivaroxaban resulted in an increased QALY while bleeding decreased from 0.5 to 12.0. This is almost similar to the results of the study by Hori et al (2020) and Salcedo et al (2019) and Soyon et al (2013) [ 9 , 11 , 21 ]. Also, Wang et al (2014) calculated the cost-effectiveness of dabigatran and rivaroxaban in comparison with warfarin in patients with AF in Singapore.…”

“…The findings indicated that the treatment of AF patients with rivaroxaban and warfarin significantly decreased bleeding and stroke (81.9% vs. 44.4% for no bleeding and 98.6% vs. 95/7% for prevention of ischemic stroke). A study conducted by Hori et al (2020) in Japan found that rivaroxaban reduced the risk of ischemic stroke compared to warfarin, and this study confirms the results of our research [ 9 ]. In a study by Kleintjens et al, the cost-effectiveness of rivaroxaban compared with warfarin was calculated for prevention of stroke in AF patients in the Belgian health system.…”

“…Cost-utility analysis is a form of costeffectiveness analysis, in which the utility is used instead of natural units to measure outcomes [8]. Although there have been several studies regarding with cost-effectiveness of rivaroxaban compared in comparison to warfarin [9][10][11][12][13], there is spare data from LMICs, and accordingly, we investigated direct medical costs, direct nonmedical costs, and indirect costs of patients who had ischemic stroke and AF and taking warfarin or rivaroxaban to compare cost-effectiveness of these drugs.…”

A Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin for Deep Vein Thrombosis (DVT) Treatment in Ethiopia

“… 16 Another study done in Japan among non-valvular atrial fibrillation patients for the treatment of stroke prevention identified that Rivaroxaban was cost-effective compared to warfarin (ICER= €24,446.42/QALY). 17 Even in different disease in US citizens, Warfarin is less cost effective compared with Apixaban for treatment of atrial fibrillation. Apixaban compared with Warfarin resulted in ICER of $53,925/QALY.…”