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Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting

(2013) PHARMACOECONOMICS. 31(10). p.909-918
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Abstract
Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines. The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk. A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of a,not sign8,809 per QALY or a,not sign7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of a,not sign35,000/QALY gained be considered. The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.
Keywords
ANTICOAGULATION, PATIENTS PREFERENCES, MYOCARDIAL-INFARCTION, QUALITY-OF-LIFE, POPULATION, MANAGEMENT, MORTALITY, UTILITY

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MLA
Kleintjens, Joris, Xiao Li, Steven Simoens, et al. “Cost-effectiveness of Rivaroxaban Versus Warfarin for Stroke Prevention in Atrial Fibrillation in the Belgian Healthcare Setting.” PHARMACOECONOMICS 31.10 (2013): 909–918. Print.
APA
Kleintjens, J., Li, X., Simoens, S., Thijs, V., Goethals, M., Rietzschel, E., Asukai, Y., et al. (2013). Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting. PHARMACOECONOMICS, 31(10), 909–918.
Chicago author-date
Kleintjens, Joris, Xiao Li, Steven Simoens, Vincent Thijs, Marnix Goethals, Ernst Rietzschel, Yumi Asukai, et al. 2013. “Cost-effectiveness of Rivaroxaban Versus Warfarin for Stroke Prevention in Atrial Fibrillation in the Belgian Healthcare Setting.” Pharmacoeconomics 31 (10): 909–918.
Chicago author-date (all authors)
Kleintjens, Joris, Xiao Li, Steven Simoens, Vincent Thijs, Marnix Goethals, Ernst Rietzschel, Yumi Asukai, Ömer Saka, Thomas Evers, Petra Faes, Stefaan Vansieleghem, and Mimi De Ruyck. 2013. “Cost-effectiveness of Rivaroxaban Versus Warfarin for Stroke Prevention in Atrial Fibrillation in the Belgian Healthcare Setting.” Pharmacoeconomics 31 (10): 909–918.
Vancouver
1.
Kleintjens J, Li X, Simoens S, Thijs V, Goethals M, Rietzschel E, et al. Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting. PHARMACOECONOMICS. 2013;31(10):909–18.
IEEE
[1]
J. Kleintjens et al., “Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting,” PHARMACOECONOMICS, vol. 31, no. 10, pp. 909–918, 2013.
@article{4322277,
  abstract     = {Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines.
The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk.
A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature.
Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of a,not sign8,809 per QALY or a,not sign7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of a,not sign35,000/QALY gained be considered.
The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.},
  author       = {Kleintjens, Joris and Li, Xiao and Simoens, Steven and Thijs, Vincent and Goethals, Marnix and Rietzschel, Ernst and Asukai, Yumi and Saka, Ömer and Evers, Thomas and Faes, Petra and Vansieleghem, Stefaan and De Ruyck, Mimi},
  issn         = {1170-7690},
  journal      = {PHARMACOECONOMICS},
  keywords     = {ANTICOAGULATION,PATIENTS PREFERENCES,MYOCARDIAL-INFARCTION,QUALITY-OF-LIFE,POPULATION,MANAGEMENT,MORTALITY,UTILITY},
  language     = {eng},
  number       = {10},
  pages        = {909--918},
  title        = {Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting},
  url          = {http://dx.doi.org/10.1007/s40273-013-0087-9},
  volume       = {31},
  year         = {2013},
}

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