OBJECTIVES：This study aimed to inform decision-making through evaluating the cost-effectiveness of Edoxaban versus Rivaroxaban, Dabigatran and Warfarin for stroke prevention in NVAF patients in mainland China.

METHODS：A Markov model with 15 health states was constructed from a payer’s perspective to estimate the costs and quality-adjusted life years (QALYs) of NVAF patients treated with Edoxaban or other oral anticoagulants. A hypothetical cohort of 1,000 patients at age 66 was simulated over a 10-year time horizon, with cycle length set at 1 month. Transition probabilities were derived from Asian subpopulation analysis of ENGAGE-AF, ROCKET-AF, RE-LY and other clinical trials. Costs associated with health states were obtained from published literature and focus group discussion. All costs were expressed as the 2018 RMB (exchange rate, 1 USD = 6.61 Chinese Yuan). Both costs and utilities were discounted at 3.0% per year. One-way sensitivity analysis on different costs was undertaken. Outcome measures included total costs, QALYs and incremental cost-effectiveness ratios (Costs per QALY gained).

RESULTS：Baseline characteristics of Asian subpopulations were comparable across the clinical trials. Compared to Warfarin group, Edoxaban, Rivaroxaban and Dabigatran, after 10-year simulation, resulted in additional QALYs gained of 150.45, 118.73, and 168.28 with incremental costs of ¥67,871,592, ¥89,916,239 and ¥102,804,106, respectively. The corresponding costs per QALYs gained (ICER) for Edoxaban, Rivaroxaban and Dabigatran, were ¥451,123, ¥757,316, and ¥610,911. Our findings suggested that Edoxaban was the most cost-effective versus Rivaroxaban and Dabigatran. Sensitivity analysis showed Edoxaban remained the most cost effective among NOACs with 30% increase in its price.

CONCLUSIONS：This present study using local inputs showed that Edoxaban may be a cost-effective alternative to other NOACs for the prevention of stroke in NVAF patients in mainland China.