OBJECTIVES : To evaluate published cost-effective analyses (CEAs) of apixaban compared with warfarin for prevention of stroke in patients with atrial fibrillation (AF).

METHODS : A systematic review of original CEA analyses was conducted using MEDLINE, EMBASE, Cochrane Library, and CINAHL. Studies were included if they were original CEA analyses that compared to apixaban to warfarin for prevention of stroke in patients with AF.

RESULTS : The seven studies included represent data from four countries. To compare estimates of the overall cost and quality adjusted life years (QALYs) from treatment with apixaban versus warfarin, each study utilized the Marcov model. The clinical efficacy and safety data that was input into the model was derived from the AVERROES and/or ARISTOTLE trial. Although ARISTOTLE data was used in each of the studies, their incremental cost effectiveness ratios (ICERs) vastly differed. ICER calculation differences were attributed to the studies’ hypothetical population, the number of health states included in the model, and the sources of utility that were used to calculate QALYs. With a willingness-to-pay (WTP) threshold of $50,000, apixaban was found to be cost-effective (CE) in five studies and cost-saving in one study. The ICERs ranged from $13,801/QALY-$93,063/QALY

CONCLUSIONS : The studies evaluated showed apixaban to be a CE alternative to warfarin in the prevention of stroke in patients with AF.