OBJECTIVES:

To assess the cost-effectiveness of apixaban versus edoxaban for stroke prevention in non-valvular atrial fibrillation (NVAF) population in Spain.

METHODS:

A previously developed Markov-model with 10 health states was customized to estimate lifetime economic and clinical outcomes in 6-week cycles. NVAF population characteristics were obtained from ARISTOTLE apixaban trial. The efficacy (clinical event rates per 100 patient-years) and safety data derived from a Bucher indirect treatment comparisons method, including warfarin-controlled ARISTOTLE and ENGAGE-AF trials data. The analysis was performed from the National Health System (NHS) and societal perspectives, including pharmaceutical costs (retail price including VAT with national deductions applied) according to SmPC authorized dosages (apixaban: 10mg/daily [5mg bid], edoxaban: 60mg/daily), cost of complications and cost of acute and long-term disease-management, obtained from national databases (€, 2018). An annual discount rate of 3% was applied for both costs and health outcomes. Incremental cost-utility/effectiveness ratios (ICER/ICUR) were obtained for apixaban versus edoxaban. Sensitivity analyses (SA) were performed to assess the robustness of the model results.

RESULTS:

In a 1,000 patients cohort , apixaban therapy would avoid 5 ischaemic strokes, 1 intracranial hemorrhage, 2 myocardial infarctions, 6 major bleeding and 29 clinically relevant non-major bleedings compared to edoxaban. Apixaban would yield 0.055 life years gained (LYG) and 0.042 additional quality-adjusted life-years gained (QALY) in comparison to edoxaban. Total incremental costs for apixaban would be €403.05/patient for NHS perspective and €325.46 for societal perspective.

ICER of €7,281 and €5,879 per LYG, and ICUR of €9,606 and €7,805 per QALY gained were for apixaban versus edoxaban from NHS and societal perspectives, respectively. Probabilistic SA obtained an 70% and 63% probability of cost-effectiveness at a €30,000/QALY threshold, respectively.

CONCLUSIONS:

According to these model outcomes, apixaban compared with edoxaban, could be considered a cost-effective alternative for stroke prevention in NVAF patients, in Spain.