Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Stroke Prevention in Atrial Fibrillation

OBJECTIVES: Strokes related to Atrial Fibrillation(AF) lead to higher mortality rates, greater disability, and longer hospitalization, resulting in significantly higher costs. The aim of the study is to conduct a cost-effectiveness analysis in the case of using warfarin versus rivaroxaban in the treatment of Stroke Prevention in AF(SPAF) from the perspective of the Turkish reimbursing institution, the Social Security Institution.

METHODS: In the study, a decision tree and a Markov model with a 30-year time horizon were created for analysis. The clinical data(minor, major, intracranial, critical organ and fatal bleeding, stroke, myocardial infarction(MI), mortality and no event; for health states: post-MI, post-stroke, post-intracranial bleeding, post-multiple event and death) used in the model was created in line with expert opinions through a survey created as a result of literature review. From economic data, drug costs are calculated based on the public price in line with the daily use dose of the relevant drug, while healthcare usage costs are obtained by recalculating the costs obtained as a result of the literature review in line with expert opinions.

RESULTS: As a result of the analysis, the life years gained for rivaroxaban were found to be 21.64, while for warfarin it was 14.42. In addition, when 30-year costs were calculated, it was found to be TRY162,651 for rivaroxaban and TRY170,223 for warfarin. According to the results of the analysis, rivaroxaban was superior in terms of both the more life years it gained and the lower cost it offered.

CONCLUSIONS: When the incremental cost-effectiveness ratio based on years of life gained is compared to rivaroxaban versus warfarin, rivaroxaban is the dominant treatment option because it is both more cost-effective and has more years of life gained. According to these results, it is clear that the use of rivaroxaban in the treatment of SPAF will benefit public finances and health.