OBJECTIVES: Our study aims to compare the use of healthcare resources and costs associated to the management of patients with non-valvular atrial fibrillation (NVAF), according to medical practice in Spain.

METHODS: This is an observational and retrospective study based on the electronic medical records from the BIG-PAC® database. The study population was patients with NVAF receiving new anticoagulant treatment with apixaban or vitamin K antagonists (VKA) between 01/01/2015 and 31/12/2017. Propensity score matching (PSM, 1:1) was used to maximize the comparability of study cohorts. Effectiveness was assessed as the incidence of ischemic stroke and systemic thromboembolisms, and major and minor bleedings. The use of healthcare resources, costs and incremental cost-effectiveness ratios were analyzed. Costs were expressed as the mean annual cost per patient in euros 2021.

RESULTS: PSM paired 2,160 patients treated with apixaban with patients treated with acenocoumarol. In comparison to acenocoumarol, apixaban reduced the incidence of strokes and systemic embolisms (3.7% vs. 2.0%) and minor bleedings (10.9% vs. 7.2%) and major bleedings (4.6% vs. 2.4%), p≤0.001 in all comparisons), as well as the mortality rate (8.3% vs. 3.7%, p<0.001). Apixaban patients required a lower use of healthcare resources compared to those needed by the acenocoumarol group, particularly nursing and primary care visits. Apixaban led to reductions of 80%, 55% and 43% in annual costs related to nursing visits (-€106/patient), hospitalizations (-€365/patient), and emergency visits (-€16/patient), respectively. Therefore, the use of apixaban led to annual cost savings of €274 (95% confidence interval: €157 - €387) per patient, from the perspective of the society.

CONCLUSIONS: The clinical improvements and the reduction of disease management costs suggested that apixaban is a cost-effective alternative for patients with NVAF, that may reduce the economic burden of this disease for the Spanish National Health System and society.