OBJECTIVES : A review was undertaken to compare and contrast global health technology assessments (HTAs) and listing recommendations of non-VKA oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF).

METHODS : Searches were conducted on national HTA agency websites to retrieve publicly available reports evaluating NOACs versus other NOACs or VKAs. Information was collected on the methods and outcomes of the economic evaluations and corresponding recommendations. Economic value was defined as cost-effectiveness or dominance based on local willingness-to-pay thresholds.

RESULTS : The review identified 33 unique reports of HTAs conducted between 2012–2017 in 14 countries (Australia, Belgium, Brazil, Canada, Colombia, France, Germany, Ireland, Norway, Poland, Scotland, Singapore, Sweden, and the United Kingdom). Most assessments were conducted in Europe (9/14) and considered clinical and economic evidence (31 reports across 12 countries). The evaluations conducted in France and Germany considered clinical evidence only. The data sources of clinical evidence in the 33 reports were predominantly from randomized controlled trials (RCTs) and network meta-analyses of RCTs. Ten countries assessed the economic value of NOACs through cost-effectiveness analyses (CEA) or cost-utility analyses (CUA), from a payer perspective. The analyses focused on NOAC-VKA comparison, and secondarily, NOAC-NOAC. Australia and Canada performed CEA and cost-minimization analyses (CMA), while Brazil and Sweden conducted CMAs. Furthermore, six countries performed budget impact analyses. Apixaban was recommended in 10/12 countries, except Brazil and Colombia. Dabigatran was recommended in 9/12 countries, except Brazil, Colombia, and Singapore. Rivaroxaban was recommended in 9/12 countries, except Brazil, Colombia, and Poland. Five countries evaluated and recommended edoxaban based on demonstrated economic value.

CONCLUSIONS : The use of cost-minimization analysis in HTAs of NOACs is limited. Most countries aligned in their final recommendations to grant patient access to NOACs for NVAF. Our results suggest a perception of clinical and economic differences among the NOACs, and the reasons behind that deserve further investigation.