OBJECTIVES : Rivaroxaban, a non-VKA oral anticoagulant (NOAC), has clinical benefits against warfarin in patients with atrial fibrillation(SPAF). CHADS₂ score and Time in Therapeutic Range(TTR) are important elements for warfarin patients in terms of stroke prevention. The aim of the study is to understand the cost and clinical benefits of rivaroxaban against warfarin with the perspective of reimbursement agency in Turkey including direct costs and clinical outcomes for TTR 60% which is already reimbursed in Turkey and CHADS₂ score 2 as recommended by global clinical guidelines.

METHODSMarkov model has been conducted depending on clinical trials, RWE and expert opinions; including for events: 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. The cost of comorbidities has been collected from published national cost data in reimbursement agency perspective. The model has been conducted for TTR 60% and CHADS₂ score 2. Mortality related with stroke and total healthcare costs for 15 years which is the expected life years on SPAF patients` average age has been calculated.

RESULTS : Rivaroxaban serves lower ICER against to Warfarin in all indicated subgroups. The calculated ICER for CHADS₂ score 2 subgroup was 16.899 TL but it was 31.819 (Turkish Lira)TL for TTR 60% subgroup.

CONCLUSIONS : These results indicate that Rivaroxaban serves better clinical and cost outcomes against warfarin. Therefore, 1^st line access to NOACs for patients who have CHADS₂ score 2 or higher is more cost effective than current reimbursement condition where NOACs prescribed for patients who has TTR 60% or lower. Decision makers need to consider providing better access conditions for NOACs in SPAF in order to gain better outcomes.