OBJECTIVES: This evaluation aimed to assess cost-effectiveness of once-daily edoxaban 60mg (30mg dose-reduced) compared with other licenced non-VKA oral anticoagulants (NOACs) for prevention of stroke and systemic embolic events among patients with non-valvular atrial fibrillation (NVAF) in the UK. METHODS: A Markov model was developed to simulate the course of disease and resource utilisation in a hypothetical cohort of patients receiving edoxaban or the other NOACs currently licensed for use in the UK: apixaban, dabigatran and rivaroxaban.

In the absence of head-to-head clinical studies between NOACs, a network meta-analysis was conducted to estimate the relative efficacy and safety of edoxaban compared with all treatments of interest. Where data were available, the analysis was based on patients with CHADS≥2; otherwise, the entire study population was used.

Health outcomes were assessed in quality-adjusted life years (QALYs). Utilities and costs were extracted from the literature and the NHS reference cost database and discounted at 3.5% per annum. Outcomes were evaluated over a lifetime time horizon. The average age of patients entering the model was 72, as in the ENGAGE-AF study.

Sensitivity analyses were conducted to evaluate the effect of uncertainty in inputs on the results. RESULTS: Edoxaban was dominant compared with rivaroxaban and dabigatran 110 mg BD. Edoxaban was dominated by apixaban and dabigatran 150 mg BD. Lifetime differences between edoxaban and comparators ranged from £394 to -£787 and 0.08 to -0.08 QALYs. Sensitivity analyses indicate the findings were robust. CONCLUSIONS: Accepting the limitations of modelling with restricted data availability and absent head-to-head trials, this analysis suggests that edoxaban is associated with similar outcomes to the other NOACs in the UK setting. Edoxaban is dominant compared with the most widely prescribed once-daily NOAC, rivaroxaban. Both dabigatran and apixaban are given twice daily, and apixaban has a higher acquisition cost than the other NOACs.