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Int J Cardiol. 2019 May 1;282:53-58. doi: 10.1016/j.ijcard.2018.11.087. Epub 2018 Nov 19.

Cost-effectiveness of rivaroxaban versus warfarin for treatment of nonvalvular atrial fibrillation in patients with worsening renal function.

Author information

1
Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, United States of America. Electronic address: salcedoj@usc.edu.
2
Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, United States of America.

Abstract

BACKGROUND:

Nonvalvular atrial fibrillation (NVAF) is highly prevalent and increases the risks of cardiovascular events. In a recent subgroup analysis, treatment response was shown to vary for patients exhibiting worsening renal function (WRF) on-treatment. It is important to understand the cost-effectiveness of novel oral anticoagulant (NOAC) use in this population.

METHODS:

A cost-effectiveness analysis (CEA) was conducted using a Markov model to determine whether NOAC rivaroxaban treatment is cost-effective relative to warfarin in NVAF patients with on-treatment WRF. Input parameters were sourced from clinical literature including a multicenter clinical trial and subgroup analysis. We studied elderly US male patients at increased risk for stroke (CHADS2 score ≥ 2) undergoing treatment for NVAF and exhibiting WRF. Main outcome measures included total healthcare costs in 2017 US dollars (societal perspective), total quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and incremental net monetary benefits (INMB) per-patient.

RESULTS:

The remaining lifetime use of rivaroxaban is associated with 5.69 QALYs at a cost of $66,075 per patient, while warfarin produced 5.22 QALYs with costs of $78,504 per patient. At a willingness-to-pay (WTP) of $150,000 per QALY, incremental net monetary benefits (INMB) per patient are $83,590. In our population, treatment with warfarin was dominated by rivaroxaban in 99.4% of 10,000 simulations.

CONCLUSIONS:

Rivaroxaban is likely a dominant treatment over warfarin in elderly US male NVAF patients exhibiting WRF, providing increased QALYs at a decreased overall cost. Application of these findings may require healthcare providers to predict which patients are likely to exhibit WRF.

KEYWORDS:

Cost-effectiveness; Markov model; Nonvalvular atrial fibrillation; Rivaroxaban; Warfarin; Worsening renal function

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