Cost-effectiveness of new oral anticoagulants in the prevention of stroke in patients with atrial fibrillation

• Published in: Best practice & research. Clinical haematology Vol. 26; no. 2; pp. 225 - 237
• Main Authors: Kansal, Anuraag R., PhD, Zheng, Ying, MS, MHSA, Pokora, Tiffany, PharmD, Sorensen, Sonja V., MPH
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2013
• Subjects: Administration, Oral; Aged; Anticoagulants - economics; Anticoagulants - therapeutic use; apixaban; Aspirin - economics; Aspirin - therapeutic use; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - pathology; Benzimidazoles - economics; Benzimidazoles - therapeutic use; Cost-Benefit Analysis; cost-effectiveness; Dabigatran; Drug Administration Schedule; Hematology, Oncology and Palliative Medicine; Humans; Intracranial Hemorrhages - chemically induced; Intracranial Hemorrhages - prevention & control; Morpholines - economics; Morpholines - therapeutic use; Pyrazoles - economics; Pyrazoles - therapeutic use; Pyridines - economics; Pyridines - therapeutic use; Pyridones - economics; Pyridones - therapeutic use; Randomized Controlled Trials as Topic; Rivaroxaban; stroke; Stroke - etiology; Stroke - pathology; Stroke - prevention & control; Thiophenes - economics; Thiophenes - therapeutic use; Venous Thromboembolism - etiology; Venous Thromboembolism - pathology; Venous Thromboembolism - prevention & control; warfarin; Warfarin - economics; Warfarin - therapeutic use; cost-effectiveness; atrial fibrillation; dabigatran; rivaroxaban; apixaban; stroke; warfarin
• ISSN: 1521-6926; 1532-1924
• DOI: 10.1016/j.beha.2013.07.012

Atrial fibrillation (AF) is a common arrhythmia and the leading cause of stroke, an event with high human and economic burden. Novel oral anticoagulants have been approved in many markets as alternatives to warfarin for stroke prevention in patients with AF – dabigatran etexilate, apixaban and rivaroxaban. Given the high burden of AF, and given that new treatments can more effectively prevent stroke than warfarin, but at higher drug cost, there has been a need for systematic evaluation of the costs and benefits of these new treatments. In this study, we summarize the findings of a systematic literature review on the cost-effectiveness of the new oral anticoagulants. We find that there is substantial heterogeneity between the studies and their numerical findings, despite using a common set of four trials for their clinical inputs. However, there is broad consensus among them that each of the novel oral anticoagulants is cost-effective versus warfarin or aspirin.