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Cost-Effectiveness Analysis of Apixaban Versus Edoxaban in Patients with Atrial Fibrillation for Stroke Prevention


  • Itziar Oyagüez

    (Pharmacoeconomics and Outcomes Research Iberia (PORIB))

  • Carmen Suárez

    (Hospital La Princesa)

  • José Luis López-Sendón

    (Hospital Universitario La Paz, IdiPaz, CIBER-CV)

  • José Ramón González-Juanatey

    (Complejo Hospitalario Universitario de Compostela)

  • Fernando Andrés-Nogales

    (Pharmacoeconomics and Outcomes Research Iberia (PORIB))

  • Jorge Suárez

    (Bristol-Myers Squibb)

  • Carlos Polanco

    (Bristol-Myers Squibb)

  • Javier Soto



Objective Our objective was to assess the cost effectiveness of apixaban versus edoxaban in the prevention of stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) in Spain. Methods We customized a Markov model with ten health states to estimate the lifetime economic and clinical outcomes in 6-week cycles. The efficacy (clinical event rates per 100 patient-years) and safety data were derived from a pairwise indirect treatment comparison. The analysis was conducted from both the national health service (NHS) and societal perspectives, and included pharmaceutical costs (retail price plus value-added tax (VAT) and applicable national deductions) according to daily dosages (apixaban 10 mg (5 mg twice daily (bid)) and edoxaban 60 or 30 mg) and complications and disease-management costs, obtained from national databases. Utilities for quality-adjusted life-year (QALY) calculations reflected EuroQoL 5-Dimension scores in patients with AF. An annual discount rate of 3% was applied for costs (€, year 2019 values) and outcomes. Results In a 1000-patient cohort, apixaban 5 mg bid versus edoxaban 60 mg could avoid five strokes, six major bleedings and 29 clinically relevant non-major bleedings (CRNMBs). Compared with edoxaban 30 mg, apixaban could avoid 21 strokes and two SEs. An increase in bleedings was observed with apixaban (seven haemorrhagic strokes, 48 major bleedings and 17 CRNMBs). Apixaban yielded 0.04 additional QALYs compared with edoxaban 60 mg or 30 mg. Incremental costs/QALY were €9639.33 and €354.22 for apixaban versus edoxaban 60 mg and edoxaban 30 mg, respectively, from the NHS perspective and €7756.62 for apixaban versus edoxaban 60 mg from the societal perspective. Apixaban was dominant versus edoxaban 30 mg from the societal perspective. Sensitivity analyses confirmed the robustness of the model. Conclusions This study suggests that apixaban 5 mg bid is a cost-effective alternative to edoxaban for stroke prevention in the AF population in Spain.

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  • Itziar Oyagüez & Carmen Suárez & José Luis López-Sendón & José Ramón González-Juanatey & Fernando Andrés-Nogales & Jorge Suárez & Carlos Polanco & Javier Soto, 2020. "Cost-Effectiveness Analysis of Apixaban Versus Edoxaban in Patients with Atrial Fibrillation for Stroke Prevention," PharmacoEconomics - Open, Springer, vol. 4(3), pages 485-497, September.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:3:d:10.1007_s41669-019-00186-7
    DOI: 10.1007/s41669-019-00186-7

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    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07


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    Cited by:

    1. Simone Rivolo & Manuela Di Fusco & Carlos Polanco & Amiee Kang & Devender Dhanda & Mirko Savone & Aristeidis Skandamis & Thitima Kongnakorn & Javier Soto, 2021. "Cost-effectiveness analysis of apixaban versus vitamin K antagonists for antithrombotic therapy in patients with atrial fibrillation after acute coronary syndrome or percutaneous coronary intervention," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-17, November.

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