A COST OUTCOMES ANALYSIS OF APIXABAN VERSUS RIVAROXABAN FOR THE TREATMENT OF PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE UNITED STATES
Author(s)
Rupesh Subash, BSc, MSc1, Toyin Ogunyannwo, PhD2, Chloe Salter, BSc3, Carissa Dickerson, PhD3, Ewa Stawowczyk, PhD3;
1Pfizer Ltd., Surrey, United Kingdom, 2Pfizer Inc., New York, NY, USA, 3Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
1Pfizer Ltd., Surrey, United Kingdom, 2Pfizer Inc., New York, NY, USA, 3Health Economics and Outcomes Research Ltd., Cardiff, United Kingdom
OBJECTIVES: Direct-acting oral anticoagulants (DOACs), including apixaban and rivaroxaban, are recommended to reduce stroke and systemic embolism risk in patients with non-valvular atrial fibrillation (NVAF). This study assessed the clinical and budget impact of apixaban versus rivaroxaban for patients with NVAF from the US Medicare perspective, incorporating generic pricing assumptions to account for anticipated price erosions following loss of exclusivity (LOE).
METHODS: Based on a published Markov model, a cost-outcomes analysis was conducted over a five-year horizon to compare outcomes between two scenarios (100% market share rivaroxaban [20 mg once-daily] or apixaban [5 mg twice-daily]). Clinical inputs were obtained from two alternative US-based retrospective studies, Graham et al. and Ray et al. US-specific costs were sourced from literature and Centres for Medicare & Medicaid Services databases (inflated to 2025 US dollars). Based on forecasted LOE dates, generic pricing was set as 65% of brand price, assuming 55% uptake in the first cycle (3 months; model start date: January 2026) with generic entry (increasing by 2.5% per subsequent cycle). Primary outcomes included incremental costs and clinical event rates (stroke, major bleeding etc.) per 1,000 patients.
RESULTS: Based on inputs from Graham et al. [Ray et al.], apixaban was associated with 725 [335] fewer total clinical events, over five-years (cumulative per 1,000 patients) versus rivaroxaban. Despite lower drug costs due to earlier generic entry of rivaroxaban (cycle 4 versus cycle 9), apixaban treatment was associated with cumulative total cost savings of $3,559,893 [$2,014,175] (cost per member per month savings $121 [$97]) at year five (per 1,000 patients) versus rivaroxaban, driven by a reduction in clinical events resulting in lower event-related costs.
CONCLUSIONS: Despite earlier introduction of generic rivaroxaban, treatment with apixaban resulted in cost-savings versus rivaroxaban over five years, driven by a reduction in clinical events, namely major bleeding.
METHODS: Based on a published Markov model, a cost-outcomes analysis was conducted over a five-year horizon to compare outcomes between two scenarios (100% market share rivaroxaban [20 mg once-daily] or apixaban [5 mg twice-daily]). Clinical inputs were obtained from two alternative US-based retrospective studies, Graham et al. and Ray et al. US-specific costs were sourced from literature and Centres for Medicare & Medicaid Services databases (inflated to 2025 US dollars). Based on forecasted LOE dates, generic pricing was set as 65% of brand price, assuming 55% uptake in the first cycle (3 months; model start date: January 2026) with generic entry (increasing by 2.5% per subsequent cycle). Primary outcomes included incremental costs and clinical event rates (stroke, major bleeding etc.) per 1,000 patients.
RESULTS: Based on inputs from Graham et al. [Ray et al.], apixaban was associated with 725 [335] fewer total clinical events, over five-years (cumulative per 1,000 patients) versus rivaroxaban. Despite lower drug costs due to earlier generic entry of rivaroxaban (cycle 4 versus cycle 9), apixaban treatment was associated with cumulative total cost savings of $3,559,893 [$2,014,175] (cost per member per month savings $121 [$97]) at year five (per 1,000 patients) versus rivaroxaban, driven by a reduction in clinical events resulting in lower event-related costs.
CONCLUSIONS: Despite earlier introduction of generic rivaroxaban, treatment with apixaban resulted in cost-savings versus rivaroxaban over five years, driven by a reduction in clinical events, namely major bleeding.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE320
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)