OBJECTIVES: Non-valvular atrial fibrillation (NVAF) is a cardiovascular condition affecting approximately 1% of the United States (US) population and is associated with substantial clinical burden. Current practice guidelines recommend anticoagulants as treatment for NVAF, with direct oral anticoagulants such as apixaban and rivaroxaban having superior adverse event profiles as compared to warfarin. Two comparative effectiveness and safety analyses of apixaban and rivaroxaban among NVAF patients in the US were recently published. Applying findings from these analyses, costs of major ischemic and haemorrhagic events were estimated for apixaban and rivaroxaban from a US payer 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 US NVAF patients. The base case analysis included rates of major ischemic and hemorrhagic events in NVAF patients treated with apixaban or rivaroxaban and unit costs for these events (in 2022 USD) from published literature. Total cost per year (TCPY) and per-treated patient cost per year (PTPCPY) were calculated for apixaban- and rivaroxaban-treated NVAF patients. Separate analyses were conducted for commercial and Medicare plan perspectives. Scenario analyses assessed the cost impact of changing market share.

RESULTS: In the base case analysis for a 1-million-member Medicare plan, combined per-patient costs of ischemic and hemorrhagic events were lower for patients treated with apixaban compared to rivaroxaban, driven by the lower likelihood of these events for apixaban, with PTPCPY of $6,727 for apixaban and $7,967 for rivaroxaban. Results were similar for a commercial perspective. Scenarios with increased rivaroxaban market shares saw additional increases in TCPY.

CONCLUSIONS: Estimated costs of management of ischemic and hemorrhagic events among NVAF patients were lower for apixaban compared to rivaroxaban by approximately 16% per patient for all perspectives, suggesting cost savings for patients switching to apixaban from rivaroxaban.