OBJECTIVES : To evaluate the cost-effectiveness of rivaroxaban over real-world treatment prescribing scenario (i.e. 23% of patients receiving warfarin, 57% of patients receiving aspirin, or 20% of patients receiving no treatment in a cohort of warfarin-eligible patients) for stroke prevention in non-valvular atrial fibrillation (NVAF) patients in China.

METHODS : A Markov model was designed from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of NVAF patients treated with rivaroxaban or real-world prescribing. Clinical data were from ROCKET AF trial or network meta-analysis to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature. The time horizon was set at patients’ lifetime and a 3-month cycle length was used in the model. All costs were expressed as the 2017 USD (exchange rate, 1 USD = 6.67 Chinese Yuan) with future costs discounted at 5% per year. One-way sensitivity analyses and probability sensitivity analyses were undertaken to further assess the uncertainty of the cost-effectiveness results of rivaroxaban over real-world treatment.

RESULTS : Rivaroxaban therapy resulted in the gain of 6.90 QALYs, with the total lifetime costs USD 17,269. And the real-world prescribing mixture resulted in 6.43 QALYs, with the costs USD 8,157. The ICER of rivaroxaban was USD 19,563 per QALY versus the real-world treatment. Sensitivity analysis indicated that the result was most sensitive to relative risk (RR) of stroke for rivaroxaban and rivaroxaban would be cost-effective, assuming a willingness-to-pay threshold of USD 24,279 per QALY.

CONCLUSIONS : It demonstrates that rivaroxaban therapy is a cost-effective alternative to real-world treatment for stroke prevention of NVAF patients in China.