OBJECTIVES: To assess the cost-effectiveness of apixaban for the prevention of stroke in patients with non valvular atrial fibrillation (NVAF) from the payer’s perspective of the Ministry of Public Healthcare in Ecuador (MPHE). METHODS: A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared to aspirin, warfarin, dabigatran in different dosage (110 mg and 150 mg) and rivaroxaban, in patients with NVAF and risk of stroke. The clinical events considered were: stroke, bleeding, myocardial infarction (MI), cardiovascular hospitalization (CVH), and treatment discontinuation (TD) of wich the data was obtained from indirect comparisons, published literature and input data from a local expert panel. All costs information 2014 (drug and adverse events) was obtained from public data sources of the MPHE.   RESULTS: In a Cohort of 1000 patients with NVAF, apixaban avoided 51 ischemic stokes and 3 bleedings vs. aspirin, 4 ischemic stokes, 28 bleedings and 11 related deaths vs. warfarin, 21 ischemic stokes and 4 related deaths vs. dabigatran 110mg, and 11 ischemic strokes, 28 bleedings and 5 related deaths vs. dabigatran 150mg and 7 ischemic stokes, 7 bleedings and 6 related deaths vs. rivaroxaban. Apixaban was associated with 0.324 life years (LYG) and 0.0.273 quality-adjusted life-years (QALYs) gain when compared to aspirin, 0.181 LYG and 0.190 QALYs gain compared to warfarin, 0.123 LYG and 0.106 QALYs gain when compared to dabigatran 110mg, 0.081 LYG and 0.07 QALYs gained compared to dabigatran 150mg and 0.059 LYG and 0.048 QALYs gained compared to rivaroxaban. Apixaban was more effective and less costly (dominant) than dabigatran 110mg and dabigatran 150mg and cost-effective alternative compared with aspirin, warfarin and rivaroxaban.   CONCLUSIONS: Apixaban is a cost effective or dominant alternative compared with treatment options for the prevention of stroke in patients with NVAF from the payer’s perspective of the Ecuatorian Ministry of public healthcare.