Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings

Autoři: Lisa A. de Jong aff001;  Jessie Groeneveld aff001;  Jelena Stevanovic aff002;  Harrie Rila aff002;  Robert G. Tieleman aff003;  Menno V. Huisman aff005;  Maarten J. Postma aff001;  Marinus van Hulst aff007
Působiště autorů: Department of PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen Research Institute of Pharmacy (GRIP), Groningen, the Netherlands aff001;  Bristol Myers Squibb, Utrecht, the Netherlands aff002;  Department of Cardiology, Martini Hospital, Groningen, the Netherlands aff003;  Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands aff004;  Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, the Netherlands aff005;  Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands aff006;  Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands aff007;  Department of Clinical Pharmacy and Toxicology, Martini Hospital, Groningen, The Netherlands aff008
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222658



Randomized clinical trials (RCTs) and real-world data (RWD) in patients with atrial fibrillation have shown that—compared to vitamin K antagonists (VKAs)—non-VKA oral anticoagulants (NOACs) are at least as effective in the prevention of ischaemic stroke, while decreasing the risk of bleeding.


We aim to evaluate the cost-effectiveness of the NOAC apixaban versus other NOACs (dabigatran, edoxaban and rivaroxaban) and VKA, for stroke prevention in patients with atrial fibrillation by including the available data both from RCT and real-world analyses of all NOACs into one integrative previously published model.


The model was updated to the current Dutch healthcare situation. The incremental cost-effectiveness ratio was calculated using either efficacy/effectiveness and safety data derived from a network meta-analysis (NMA) synthesizing NOAC RCTs or RWD. We conducted a systematic literature search to identify eligible publication to best inform the RWD-based analysis. Additional sensitivity and scenario analyses were conducted to test the robustness of the outcomes.


In the NMA-based analysis, apixaban appeared to be cost-effective compared to VKA (€3,506 per quality adjusted life-year) and dominant (cost-saving and more effective) over dabigatran 110 mg, dabigatran 150 mg, edoxaban and rivaroxaban. In the RWD-based analysis, apixaban was dominant over all other anticoagulants. In the scenario analysis apixaban appeared to be not cost-effective compared to dabigatran 150 mg, when using equal event-unrelated treatment discontinuation rates for each drug. In all other scenarios apixaban is cost-effective or cost-saving compared to VKA and other NOACs.


Based on RCTs as well as RWD, we conclude that apixaban is generally cost-effective or even cost-saving (less costly and more effective) compared to VKA and other NOACs in the overall population of patients with atrial fibrillation.

Klíčová slova:

Medicine and health sciences – Neurology – Cerebrovascular diseases – stroke – Ischemic stroke – Hemorrhagic stroke – Vascular medicine – Cardiology – Arrhythmia – Atrial fibrillation – Myocardial infarction – Diagnostic medicine – Signs and symptoms – Pathology and laboratory medicine – Hemorrhage – Social sciences – Economics – Economic analysis – Cost-effectiveness analysis – Physical sciences – Chemistry – Chemical compounds – Organic compounds – Vitamins – B vitamins – vitamin K – Organic chemistry – Mathematics – Statistics – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Metaanalysis


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