Cost-effectiveness of Apixaban vs Warfarin for Secondary Stroke Prevention of Atrial Fibrillation

OBJECTIVE To compare the cost-effectiveness of apixaban vs warfarin for secondary stroke prevention in patients with atrial fibrillation in China. METHODS Using standard methods, a decision tree and a Markov decision model were created based on the estimated cost of apixaban and data from the Apixaban for Reduction in Stroke in Atrial Fibrillation (ARISTOTLE) trial. The cost and quality-adjusted life expectancy were quantified resulting from apixaban 5 mg twice daily compared with those from warfarin therapy targeted to an international normalized ratio of 2–3. RESULTS Warfarin therapy resulted in a quality-adjusted life expectancy of 5.614 years at a cost of 40 126 yuan. In comparison, treatment with apixaban led to a quality-adjusted life expectancy of 6.256 years at a cost of 271 826 yuan. Therefore, apixaban provided a gain of 0.642 quality-adjusted life-years (QALYs) at an additional cost of 231?700 yuan, resulting in an incremental cost-effectiveness ratio of 360 903 yuan per QALY, which was >3 times per capita GDP. The findings were robust in univariate sensitivity analyses varying model inputs across plausible ranges. CONCLUSION Under the current economic situation in China, apixaban appears to have no cost-effectiveness relative to warfarin for stroke prevention in patients with atrial fibrillation. It is only recommend in some cities with highly developed economics.