OBJECTIVES:The objective of this analysis was to examine the cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in non-valvular atrial fibrillation (NVAF) patients in Japan.

METHODS:This was a cost-utility analysis adapting a previously published Markov model to evaluate the cost-effectiveness of rivaroxaban in Japanese NVAF patients. The analysis was conducted from a public healthcare payer’s perspective. The health state used in the model included ischemic stroke, systemic embolism, intracranial bleed, major extracranial bleed, minor extracranial bleed, myocardial infarction and death. The cycle time was three months, and the time horizon was set at a patient’s lifetime (30 years). Baseline event risks were obtained from the Japanese phase III study of rivaroxaban, J-ROCKET (trial NCT00494871). Treatment effect data were obtained from a network meta-analysis which considered J-ROCKET trial and warfarin trials. The model was populated predominantly with Japanese inputs in respect of the baseline patients’ characteristics, mortality background, costs and utility values. Input data were obtained from literature or official Japanese sources. The outcomes of the model included the number of total and incremental quality-adjusted life-years (QALYs), total and incremental costs and incremental cost-effectiveness ratio (ICER) (i.e. cost per QALY gained). In a scenario analysis, treatment effect data were derived from the same network meta-analysis but considered both clinical trials of rivaroxaban irrespective of trial location (J-ROCKET and the international phase III study, ROCKET AF).

RESULTS:In comparison with warfarin, rivaroxaban was estimated to increase the number of QALYs by 0.535 and to decrease the total costs by ¥118,892. As a result, rivaroxaban was found to be a dominant strategy compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2,873,499 per QALY.

CONCLUSIONS:The present analysis indicates that rivaroxaban is a cost-effective treatment over warfarin for the treatment of Japanese NVAF patients.