Cost-Effectiveness of Rivaroxaban Compared to Warfarin for Stroke Prevention in Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Rivaroxaban is noninferior to warfarin for preventing stroke or systemic embolism in patients with high-risk atrial fibrillation (AF) and is associated with a lower rate of intracranial hemorrhage (ICH). We assessed the cost-effectiveness of rivaroxaban compared to adjusted-dose warfarin for the prevention of stroke in patients with nonvalvular AF. METHODS: We built a Markov model using the Korean Health Insurance Review & Assessment Service database. The base-case analysis assumed a cohort of patients with prevalent AF who were aged 18 years or older without contraindications to anticoagulation. RESULTS: Number of patients with CHA₂DS₂-VASc scores 0, 1 and ≥2 were 56 (0. 2%), 1, 944 (6. 3%) and 28, 650 (93. 5%), respectively. In patients with CHA₂DS₂-VASc scores ≥2, the incidence rate of ischemic stroke was 3. 11% and 3. 76% in warfarin and rivaroxaban groups, respectively. The incidence rates of ICH were 0. 42% and 0. 15%, and those of gastrointestinal bleeding were 0. 32% and 0. 15% in warfarin and rivaroxaban, respectively. Patients with AF treated with rivaroxaban lived an average of 11. 8 quality-adjusted life years (QALYs) at a lifetime treatment cost of 20, 886. Those receiving warfarin lived an average of 11. 4 QALYs and incurred costs of 17, 151. Patients with rivaroxaban gained an additional 0. 4 QALYs over a lifetime with an additional cost of 3, 735, resulting in an incremental cost-effectiveness ratio of 9, 707 per QALY. CONCLUSIONS: Patients who had been treated with rivaroxaban may be a cost-effective alternative to warfarin for stroke prevention in Korean patients with AF.