OBJECTIVES: Patients with non-valvular atrial fibrillation (NVAF) are five times more likely to suffer a stroke, resulting in enormous personal, social and economic costs. For more than 50 years, vitamin K antagonists (VKAs) have been the primary medication for stroke prevention. Nevertheless, VKA therapy requires frequent monitoring, is limited by a narrow therapeutic window and is associated with an increased risk of bleeding. Apixaban, a non-vitamin K oral anticoagulant (NOAC), has shown superior efficacy and reduced risk of major bleeding compared to VKA in the ARISTOTLE trial. In this study we extrapolate the health benefits of apixaban compared to VKA therapy to the German NVAF population to quantify the potential societal effects of apixaban from 2017 through 2030.

METHODS: We estimated the size of the apixaban population according to a claims-data based analysis in Germany and the predicted market share of apixaban. A Markov model based on the ARISTOTLE trial comparing apixaban and VKA for anticoagulation was applied to the German social health insurance (SHI) data to calculate the occurrence of strokes and systemic embolisms (SE), major bleeds and deaths on the patient level. To extrapolate the results of the Markov model to the entire German NVAF population, we created a dynamic population model. It links population forecast with epidemiological data and uses the event risks from the Markov model to quantify the potential for reducing mortality and morbidity.

RESULTS: In comparison to VKA therapy the administration of apixaban prevents 52,185 additional major clinical events in the assumed German NVAF population from 2017 through 2030. This includes 15,383 non-fatal strokes or SEs, 22,483 non-fatal major bleeds, and 14,319 deaths, corresponding to 109,887 gained life years.

CONCLUSIONS: We showed that utilization of apixaban instead of VKA for stroke prevention can lead to considerable reduction of mortality and morbidity in the German NVAF patient population.