OBJECTIVES: Rivaroxaban, a member of new oral anticoagulants(NOAC), has clinical benefits against to warfarin for stroke prevention in atrial fibrilation patients. Time in Therapeutic Range(TTR) is an important element for warfarin patients in terms of stroke preventation. The aim of the study to understand the cost and clinical benefits of rivaroxaban against to warfarin for different TTRs in Turkey.

METHODS: A markov model has been conducted depending on head to head clinical trials, real life data and expert opinions including minor bleeding, major bleeding, intracranial bleeding, critical organe bleeding, fatal bleeding, stroke, myocardial infarctus(MI), mortality and no event for events, post-MI, post-stroke, post-intracranial bleeding, post-multiple event and death for health states. An expert survey has been conducted for understanding the cost of each event and health state. Cost of each event and health state has been calculated depending on expert survey and Social Security Institution`s reimbursement list. Patient profile has been set as CHADS2 Score – 3 and 60 years old. The model has been conducted for different TTR values as 65.7-100%, 58.6-65.7%, 50.7-58.5% and 0-50.6%. Mortality related with stroke and total healtcare cost has been calculated.

RESULTS: Rivaroxaban serves lower cost in all TTRs as 1362 TL, 1184 TL, 1301 TL and 1737 TL for TTR 65.7-100%, 58.6-65.7%, 50.7-58.5% and 0-50.6% in favor of Rivaroxaban versus warfarine, respectively. Rivaroxaban also serves lower mortality rates in all TTRs as -18%, -15%, -16% and -21%, respectively.

CONCLUSIONS: Clinical guidelines refers Rivaroxaban as a NOAC for stroke prevention in atrial fibrilation. Depending on model, it is well stated that Rivaroxaban serves better clinical and cost outcomes against to warfarin in a given patient profile for all TTRs. Decision makers and clinicians are needed to consider to use Rivaroxaban for stroke prevention in atrial fibrilation in Turkey for saving healthcare services cost and gain better clinical outcomes.