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Real-world cost-effectiveness of rivaroxaban and apixaban vs VKA in stroke prevention in non-valvular atrial fibrillation in the UK

Author

Listed:
  • Kevin Bowrin

    (Bayer Corporation - Bayer Corporation)

  • Jean-Baptiste Briere

    (BAYER AG - Pharma Research)

  • Pierre Lévy

    (Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique)

  • Aurélie Millier

    (Creativ-Ceutical France - Creativ-Ceutical)

  • Jean Tardu

    (Creativ-Ceutical France - Creativ-Ceutical)

  • Mondher Toumi

    (CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie - AMU - Aix Marseille Université)

Abstract

Background: Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives: An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods: The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged.

Suggested Citation

  • Kevin Bowrin & Jean-Baptiste Briere & Pierre Lévy & Aurélie Millier & Jean Tardu & Mondher Toumi, 2020. "Real-world cost-effectiveness of rivaroxaban and apixaban vs VKA in stroke prevention in non-valvular atrial fibrillation in the UK," Post-Print hal-03120333, HAL.
    • Handle: RePEc:hal:journl:hal-03120333
    DOI: 10.1080/20016689.2020.1782164
    Note: View the original document on HAL open archive server: https://hal.science/hal-03120333
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    References listed on IDEAS

    as
    1. Kevin Bowrin & Jean-Baptiste Briere & Laurent Fauchier & Craig Coleman & Aurélie Millier & Mondher Toumi & Emilie Clay & Pierre Levy, 2020. "Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
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