OBJECTIVES: To evaluate cost-effectiveness of the novel oral anticoagulant apixaban compared to warfarin and aspirin in patients with NVAF from the Russian Federation national health care system perspective. METHODS: Cost-effectiveness analysis was based on a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER) for apixaban compared to warfarin and aspirin over lifetime horizon in vitamin K antagonists (VKA) suitable and VKA unsuitable patients with NVAF, respectively. The model enclosed cardiovascular event rates derived from the randomized clinical trials: ARISTOTLE and AVERROES. The following cardiovascular events were considered: ischemic and hemorrhagic stroke, intracranial hemorrhage, systemic embolism, other major bleeds, clinically relevant non-major bleeds, myocardial infarction and cardiovascular hospitalizations. Characteristics of the baseline patients’ cohort including quality of INR control corresponded to the local population. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price in 2013. Cost-effectiveness threshold was set at 1,4 million rubles per quality-adjusted life year (QALY) gained and corresponded to the three times GDP per capita in the Russian Federation in 2013. One-way sensitivity analyses were undertaken to examine the effects of model drivers. RESULTS: In the base case analysis it was demonstrated that apixaban compared to warfarin and aspirin provided additional 0.187 and 0.214 QALYs, respectively. With that estimated ICER for apixaban compared to warfarin and aspirin was 603.92 and 473.02 thousands rubles per QALY gained, respectively. Sensitivity analysis indicated that results were robust over explored range of inputs. CONCLUSIONS: According to the results of the modeling study apixaban may be considered as a cost-effective alternative to warfarin in VKA suitable patients and as a cost-effective alternative to aspirin in VKA unsuitable patients for NVAF treatment from the Russian Federation national health care system perspective.