DECISION MODEL EVALUATING CLINICAL EVENT-RELATED COSTS OF PERSISTING WITH APIXABAN COMPARED WITH SWITCHING TO RIVAROXABAN AFTER A BLEEDING EVENT IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE UNITED STATES
Author(s)
Rupesh Subash, BSc, MSc1, Sofie Czarnota-Bojarski, BA, MSc2, Toyin Ogunyannwo, BKin, MPH3, Anna Maliouri, BSc, MSc2;
1Pfizer, Surrey, United Kingdom, 2FIECON, London, United Kingdom, 3Pfizer, New York City, NY, USA
1Pfizer, Surrey, United Kingdom, 2FIECON, London, United Kingdom, 3Pfizer, New York City, NY, USA
OBJECTIVES: Direct oral anticoagulants (DOACs) reduce stroke/systemic embolism (SE) risk in patients with non-valvular atrial fibrillation (NVAF), but bleeding remains an unintended consequence that often leads to treatment interruption, discontinuation, or switching. A recent real-world analysis found that, among NVAF patients who experienced a bleeding event after initiating apixaban, switching to rivaroxaban increased the risk of major bleeding (MB), while stroke/SE risk remained similar. Given the limited evidence on the economic implications of switching following a bleed, this study aimed to compare clinical event-related costs between: (1) patients who initiated and persisted on apixaban (‘persistent users’) following a bleed and (2) patients who switched from apixaban to rivaroxaban (‘switchers’) following a bleed.
METHODS: A decision model was developed to evaluate the cost associated with MB and stroke/SE under each scenario over 1-year from a US Medicare perspective. Incidence rates/hazard ratios were sourced from a published real-world analysis. Epidemiological inputs were obtained from published literature, and market shares were sourced from a US prescription claims database. Costs were sourced from public databases and published literature (2023 USD value). Incremental event costs were calculated as the cost difference between switchers and persistent users.
RESULTS: After applying the eligibility criteria, 10,268 patients with prevalent NVAF who experienced a bleeding event while on apixaban therapy were identified as persistent users. Switching these patients from apixaban to rivaroxaban was associated with an additional 128 stroke and 443 MB events, resulting in an estimated $6.95 million annual incremental costs (incremental costs of $56.38 per patient per month and $0.58 per member per month) compared to persistent apixaban users.
CONCLUSIONS: From a Medicare perspective, switching from apixaban to rivaroxaban after a bleeding event in patients with NVAF was associated with an increase in clinical event-related costs compared with persisting on apixaban, primarily driven by the increased risk of MB.
METHODS: A decision model was developed to evaluate the cost associated with MB and stroke/SE under each scenario over 1-year from a US Medicare perspective. Incidence rates/hazard ratios were sourced from a published real-world analysis. Epidemiological inputs were obtained from published literature, and market shares were sourced from a US prescription claims database. Costs were sourced from public databases and published literature (2023 USD value). Incremental event costs were calculated as the cost difference between switchers and persistent users.
RESULTS: After applying the eligibility criteria, 10,268 patients with prevalent NVAF who experienced a bleeding event while on apixaban therapy were identified as persistent users. Switching these patients from apixaban to rivaroxaban was associated with an additional 128 stroke and 443 MB events, resulting in an estimated $6.95 million annual incremental costs (incremental costs of $56.38 per patient per month and $0.58 per member per month) compared to persistent apixaban users.
CONCLUSIONS: From a Medicare perspective, switching from apixaban to rivaroxaban after a bleeding event in patients with NVAF was associated with an increase in clinical event-related costs compared with persisting on apixaban, primarily driven by the increased risk of MB.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE217
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)