OBJECTIVES: This evaluation aimed to assess the cost-effectiveness of edoxaban 60mg versus warfarin for the prevention of stroke and systemic embolic events among patients with non-valvular atrial fibrillation (NVAF) in the UK, from the perspective of the NHS. METHODS: A Markov model was developed to simulate the course of disease in hypothetical cohorts of patients with NVAF and to assess the cost-effectiveness of edoxaban versus the current UK standard of care, warfarin. The model used data from the ENGAGE study, and was based on patients with CHADS ≥2.

Utility values were derived from systematic literature reviews. Costs were extracted from the literature and the NHS reference cost database; both were discounted at 3.5% per annum. Health outcomes were assessed in quality-adjusted life years (QALYs), and evaluated over a lifetime time horizon.

Deterministic and probabilistic sensitivity analyses (PSA) were conducted to evaluate the effect of uncertainty in input parameters on the results. RESULTS: In the base case analysis (CHADS ≥2), the incremental cost-effectiveness ratio (ICER) for edoxaban compared with warfarin was £12,881 per QALY gained. At a threshold of £20,000 per QALY, the net monetary benefit associated with edoxaban was £1,406.

Edoxaban was also cost effective compared with warfarin in higher risk (CHADS≥3) and higher anticoagulant control (cTTR≥60%) subgroups (ICER £7,012 and £20,376 per QALY, respectively).

Sensitivity analyses support these findings, and show that conclusions are robust to alternative assumptions about model inputs. Starting age, edoxaban cost, monitoring costs and mortality due to non-ICH major bleeds are the drivers of the results. PSA indicates that 82% of simulations are in the north-east quadrant of the cost-effectiveness plane for this comparison, and that the probability that edoxaban is cost-effective versus warfarin is more than 50%. CONCLUSIONS: Compared with warfarin, edoxaban represents a cost-effective alternative for stroke prevention in UK patients with NVAF.