Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis

Abstract

Edoxaban, an oral direct factor Xa inhibitor, has been found non-inferior to warfarin for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), with a lower rate of intracranial bleeding. The aim of our investigation was to assess the cost-effectiveness of edoxaban versus warfarin from the perspective of the Italian health-care system. A Markov decision model was used to evaluate lifetime cost and quality-adjusted life expectancy of NVAF patients treated with warfarin or edoxaban. Transition probabilities were obtained from the ENGAGE AF-TIMI 48 trial, cost estimates were based on Italian prices and tariffs, utilities were obtained from the literature. One-way and second-order sensitivity analyses were performed. In the base case, lifetime costs were €18,658 for edoxaban and €14,060 for warfarin. Discounted quality-adjusted survival was 9.022 years for edoxaban and 8.425 years for warfarin, leading to an incremental cost-utility ratio of €7,713 per quality-adjusted life year (QALY) gained. Results were sensitive to time horizon, time in therapeutic range of warfarin and to the relative impact of warfarin versus edoxaban therapy onto quality of life. Probabilistic sensitivity analysis showed edoxaban to be cost-effective versus warfarin in 92.3 % of the simulations at a willingness-to-pay threshold of €25,000 per QALY. In conclusion, edoxaban proved to be a cost-effective alternative to warfarin in patients with moderate-to-high-risk NVAF.

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

“…Not only would large quantities of therapy changes challenge patients and clinicians, but the mass of new NOAC prescription would also have relevant economic influence on the country's obligatory health insurance system covering anticoagulant treatment. It has been shown that NOACs can be cost-effective in specific settings despite higher pharmaceutical costs, because overall costs for anticoagulation related outpatient visits and hospitalizations were reduced compared to warfarin treatment [80][81][82][83][84]. However, just like clinical outcomes, also cost-efficiency estimations have been demonstrated to depend on TTR levels achieved in the VKA group [85,86].…”

Edoxaban in Atrial Fibrillation and Venous Thromboembolism—Ten Key Questions and Answers: A Practical Guide

“…Because of the better safety profile compared with VKAs, leading to a consistent saving in direct healthcare costs, all NOACs are likely cost-effective. This is probably also true with edoxaban [5]. Edoxaban price conditions in Europe will be similar to that of other NOACs.…”

Edoxaban in the prevention and treatment of thromboembolic complications from a clinical point of view

“…In a study aimed to determine the cost-effectiveness of edoxaban versus warfarin in NVAF patients from the perspective of the Italian healthcare system, edoxaban was costeffective versus warfarin in 92.3% of the simulations at a willingness-to-pay threshold of 25,000 euros per quality-adjusted life year [92]. A study performed in Germany showed that the willingness-to-pay threshold was lowest for 60-mg edoxaban compared with all direct oral anticoagulants and for 30-mg edoxaban compared with dabigatran and rivaroxaban [93].…”