OBJECTIVES:

To estimate and compare costs associated with all-cause healthcare resource use (HCRU), stroke/systemic embolism (SE) and major bleedings (MB) between patients with non-valvular atrial fibrillation (NVAF) initiating apixaban and patients initiating other oral anticoagulants (OAC).

METHODS:

An observational retrospective cohort generated from the French National Health System healthcare claims database (SNDS). Patients were included between 2014/01/01 and 2016/12/31 and followed until 2016/12/31. We used 4 sub-cohorts of AC-naive patients with NVAF, respectively initiating apixaban, dabigatran, rivaroxaban or VKAs. We matched patients initiating apixaban with patients initiating each of the other OACs using 1:n propensity score matching. We estimated all-cause HCRU costs and events-related costs from a medical care perspective by OAC treatment (euros) per patient per month (PPPM). We compared costs between matched patients initiating apixaban and those initiating each of the OAC using generalised linear models with gamma distribution and two-part models.

RESULTS:

There were 175,766 patients in the apixaban (n=68,208)-VKA (n=107,558) matched cohort, 42,490 in the apixaban (n=21,245)-dabigatran (n=21,245) matched cohort, and 181,809 in the apixaban (n=81,759)-rivaroxaban (n=100,050) matched cohort. Patients initiating apixaban had lower all-cause HCRU costs than patients initiating VKA (€1,105 vs. €1,578; p<0.0001), dabigatran (€993 vs. €1,140; p<0.0001) and rivaroxaban (€1,013 vs. €1,088; p<0.0001). Patients initiating apixaban also had lower costs related to stroke/SE and MB than patients initiating VKA (respectively €183 vs.€449; p<0.0001 and €147 vs.€413; p<0.0001), rivaroxaban (respectively €145 vs.€197; p<0.0001 and €129 vs.€193; p<0.0001), and lower costs related to stroke/SE than patients initiating dabigatran (€135 vs.€192; p<0.02). Costs related to MB were not significantly different in patients initiating apixaban versus patients initiating dabigatran (€119 vs.€149; p=0.07).

CONCLUSIONS:

All-cause HCRU and most events-related costs were lower in patients initiating apixaban compared to patients initiating other OAC. These findings suggest that apixaban may be cost-saving (all-cause HCRU costs) compared to all therapeutical alternatives.