OBJECTIVES: For many patients with atrial fibrillation (AF) at moderate-to-high risk of stroke, clinically significant bleeding from anticoagulants remains a concern, leading to withholding or discontinuation of anticoagulation. Patients who are unsuitable for or inadequately treated with currently available anticoagulants remain at higher risk for stroke and systemic embolism. This early economic analysis explored the potential cost-effectiveness of a hypothetical new therapy that reduces the risk of stroke in patients with AF who are unsuitable for treatment with currently available anticoagulants.

METHODS: Following NICE guidance, a Markov model was developed to reflect the clinical pathways typical of patients with AF at moderate-to-high risk of stroke who are unsuitable for treatment with currently available anticoagulants. Use of a hypothetical new treatment was compared with usual care from a UK perspective. A plausible range of stroke risk for the new treatment was assessed. Total costs and quality-adjusted life years over a lifetime were compared.

RESULTS: Compared to usual care, a new treatment that reduced the risk of stroke by at least 9% was cost-effective at a £30k/QALY threshold assuming a monthly cost that is 20% higher than apixaban, a commonly prescribed anticoagulant, and relative risks of 0.75, 1.3, and 1.0 for myocardial infarction, bleeds, and intracranial hemorrhage versus usual care. Considering a range between 0.5-0.8 for the relative risk of stroke versus usual care, the new treatment remained cost-effective up to a price 2.8-14 times higher than apixaban.

CONCLUSIONS: A new treatment option for patients with AF at moderate-to-high risk of stroke who are unsuitable for treatment with currently available anticoagulants is a potentially cost-effective treatment option.