OBJECTIVES: Major ischemic or hemorrhagic events and their associated costs among anticoagulated non-valvular atrial fibrillation (NVAF) patients have not been extensively evaluated in Switzerland. A large comparative effectiveness and safety analysis of apixaban and rivaroxaban among NVAF patients in the United States (US) was recently published. Applying findings from this large retrospective cohort analysis, costs of major ischemic and haemorrhagic events were estimated for apixaban and rivaroxaban from a Swiss health care system perspective.

METHODS: A cost model was developed to estimate the costs associated with treatment of atrial fibrillation with Apixaban or rivaroxaban in a 1-year time horizon among NVAF patients ≥65 years in Switzerland. The base case analysis included: 1) equal market shares for apixaban, and rivaroxaban. 2) Adjusted rates of major ischemic and hemorrhagic events in NVAF patients treated with apixaban or rivaroxaban and 3) Unit costs for major ischemic and hemorrhagic events (in 2022 CHF) obtained from the Swiss inpatient tariff system (Swiss DRG 2022). Total cost per year (TCPY) and Per-treated patient per month (PTPM) were calculated for apixaban and rivaroxaban treated NVAF patients. Scenario analyses assessed the impact of changing market share on TCPY.

RESULTS: The base case analysis included 10,000 NVAF patients aged 65 years and older, costs of ischemic and hemorrhagic events were 32.2% lower for apixaban compared to rivaroxaban, driven by the lower likelihood of these events for apixaban:1) TCPY for apixaban was CHF 957,057 and CHF 1,412,139 for rivaroxaban. 2) PTPCM was CHF 210 for apixaban and CHF 310 for rivaroxaban. Scenarios with increased rivaroxaban market shares resulted in further lower costs of ischemic and hemorrhagic events for apixaban.

CONCLUSIONS: In this hypothetical cost model, the estimated costs of management of ischemic and hemorrhagic events among apixaban-treated NVAF patients were lower compared to rivaroxaban-treated patients in the Swiss setting.