November 1, 2013Circulation Cardiovascular Quality and Outcomes
Cost-Effectiveness of Oral Anticoagulants for Treatment of Atrial Fibrillation
Key result
Apixaban, rivaroxaban, and dabigatran cost $93,063, $111,465, and $140,557 per additional QALY gained compared with warfarin, making apixaban optimal at a $100,000/QALY threshold.
Why the study?
Are novel oral anticoagulants (dabigatran, apixaban, rivaroxaban) cost-effective compared to warfarin in patients with newly diagnosed atrial fibrillation?
Population
Patients with newly diagnosed atrial fibrillation who were eligible for treatment with warfarin
Comparison
Novel oral anticoagulants vs Warfarin therapy
Design
Other
Authors
Discussion
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Implication
Apixaban may be preferred at a $100,000/QALY threshold; leaves open whether NOACs consistently offer value versus warfarin given sensitivity to assumptions.
Structured PICO
Are novel oral anticoagulants (dabigatran, apixaban, rivaroxaban) cost-effective compared to warfarin in patients with newly diagnosed atrial fibrillation?
P
Population
Patients with newly diagnosed atrial fibrillation who were eligible for treatment with warfarin
I
Intervention
Novel oral anticoagulants (dabigatran 150 mg BID, apixaban 5 mg BID, rivaroxaban 20 mg QD)
C
Comparator
Warfarin therapy
O
Outcome
Cost per additional quality-adjusted life year (QALY) gained
Apixaban appears to be the optimal anticoagulation strategy at a $100,000/QALY threshold, but this finding is highly sensitive to efficacy and cost assumptions, suggesting NOACs may not consistently represent good value for money compared to warfarin.
Limitations
- Finding is sensitive to assumptions about efficacy and cost
- In probabilistic sensitivity analysis, warfarin was optimal in an equal number of iterations
- Sensitive to assumptions about efficacy and cost
Cite This Study
Canestaro et al. (2013) studied newly diagnosed atrial fibrillation. apixaban, rivaroxaban, and dabigatran vs. warfarin was evaluated on cost per additional quality-adjusted life year gained. Apixaban, rivaroxaban, and dabigatran cost $93,063, $111,465, and $140,557 per additional QALY gained compared with warfarin, making apixaban optimal at a $100,000/QALY threshold.