OBJECTIVES: Reference clinical guidelines recommend non-VKA anticoagulants (NOACs) over vitamin K antagonists (VKA) for preventing stroke and systemic embolism in Nonvalvular Atrial Fibrillation (NVAF) patients; nonetheless, in Spain, the local Therapeutic Positioning Report positions NOACs as a second line therapy, in part due to budget concerns. This analysis estimated, for a 10-year horizon, the clinical and economic impact associated to an increase in the use of NOACs versus VKA in anticoagulated patients with NVAF in Spain.

METHODS: A prevalence-based Markov model was developed. Outcomes of interest were stroke, systemic embolism, major extracranial, intracranial hemorrhages and deaths. Population was distributed according to NOACs (rivaroxaban, dabigatran, apixaban) and VKA (acenocumarol) usage rates (base case: 39% NOACs vs. 61% VKA). Efficacy, safety and mortality associated with each treatment were derived from real-life data. Drug, anticoagulated patient follow-up and event costs were included (€, 2,019). Four alternative scenarios with hypothetical increases in the use of NOACs versus VKA (70% NOACs vs. 30% VKA) were analysed. A univariate sensitivity analysis was performed.

RESULTS: For the base-case, the cumulative (10-years) number of events and deaths were 399,141 with a mean annual cost/patient of €1,957. In the alternative scenario, the increase in use of NOACs reduced the number of events and deaths (-37,937) and the cost/patient (€1,940). The preferential use of rivaroxaban could lead to a highest reduction in strokes and deaths (-3,584 and -35,536) compared to dabigatran (-872 and -24,657) and apixaban (-1,886 and -24,657) and cost/patient (€1,933; €1,949 and €1,942, respectively). AF incidence was the parameter with greatest impact in the sensitivity analysis.

CONCLUSIONS: A less restrictive prescription scenario in Spain, with an increased NOACs use, would translate in better health outcomes, lower mortality and a lower cost per patient, being rivaroxaban the NOAC associated with lower strokes, mortality and cost.