Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation

Figure 1. Schematic representation model. ASA, aspirin CRNM, clinically relevant non-major; ICH, intracranial haemorrhages; NVAF, non-valvular atrial fibrillation; AC, anticoagulant; IS, ischaemic stroke; HS, haemorrhagic stroke. ‘M’ represents a Markov process with 11 health states that are identical for each of the treatment options. All patients remain in the ‘NVAF’ state until one of stroke, bleed, SE, MI, treatment discontinuation, or death occurs. The transition probabilities of these events depend on the treatment. For patients on second-line aspirin ‘NVAF subsequent ASA’ the events are identical however patients cannot experience any further discontinuation. Triangles indicate which health state the patient enters after an event. Health states coloured in blue are permanent health states, with the remainder being transient health states occurring for a maximum period of 6 weeks before returning to the prior or subsequent health state.

Figure 2. (A) One-way sensitivity analysis of apixaban vs. warfarin. (B) One-way sensitivity analysis of apixaban vs. aspirin. Rates are displayed per 100 patient-years. The solid vertical line represents the base–case incremental incremental cost-effectiveness ratio for apixaban compared with warfarin or aspirin. Horizontal bars indicate the range of incremental incremental cost-effectiveness ratios obtained by setting each variable to the values shown in the white boxes while holding all other values constant.

Figure 3. (A) Probabilistic sensitivity analyses for apixaban vs. warfarin. (B) Probabilistic sensitivity analyses for apixaban vs. aspirin. Each line represents a cost-effectiveness threshold representing the maximum amount society is willing to pay for a QALY gain. Apixaban is a cost-effective alternative in cases that fall to the right of this line; apixaban is not a cost-effective alternative in cases that fall to the left of this line.