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Cost-Effectiveness Analysis of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation in Taiwan

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Abstract

Background and Objectives

The aim of this study was to evaluate the cost effectiveness of novel oral anticoagulants (NOACs) for stroke prevention among atrial fibrillation (AF) patients by incorporating Taiwanese demographic information derived from a population-based database, the National Health Insurance Research Database (NHIRD), into cost-effectiveness analysis.

Methods

From 1 January to 31 December 2012, 98,213 AF patients were selected from the NHIRD database. A Markov model was constructed that combined published secondary data with the Taiwan NHIRD to compare the cost and incremental cost effectiveness of apixaban 5 mg twice daily, dabigatran 110 or 150 mg twice daily, rivaroxaban 20 mg once daily, and warfarin.

Results

The lifetime costs of warfarin, dabigatran 110 mg, dabigatran 150 mg, rivaroxaban 20 mg, and apixaban 5 mg were US$10,660, US$13,693, US$13,426, US$13,455, US$15,965, respectively. Apixaban resulted in an incremental cost effectiveness of US$39,351, US$27,039, US$41,298, and US$48,896 per quality-adjusted life-year (QALY) compared with warfarin, dabigatran 110 mg, dabigatran 150 mg, and rivaroxaban 20 mg, respectively. In Monte-Carlo analyses, apixaban 5 mg, rivaroxaban 20 mg, warfarin, and dabigatran 110 mg were cost effective in 83, 10.4, 7, and 0.8%, respectively, of the simulations using a willingness-to-pay (WTP) threshold of US$50,000 per QALY.

Conclusions

Apixaban was more cost effective than warfarin, dabigatran, and rivaroxaban for stroke prevention in patients with AF. Among the anticoagulant therapies, the WTP threshold of apixaban was about US$50,000 per QALY gained. These cost-effectiveness estimations provide useful information to aid clinical decision making in stroke prevention for AF patients.

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Acknowledgements

The authors thank the National Health Research Institutes (NHRI) for providing the National Health Insurance Research Database (NHIRD). The study data were partly retrieved from the NHIRD, which is managed by the National Health Insurance Administration (NHIA), Ministry of Health and Welfare, and maintained by the NHRI in Taiwan. The results, interpretation, and conclusions of this paper do not represent the opinions of the NHIA, Ministry of Health and Welfare, or the NHRI.

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Authors and Affiliations

  1. Department of Midwifery and Women Care, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Min-der Road, Bei-tou district, Taipei, Taiwan, ROC

    Chieh-Yu Liu

  2. Department of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Min-der Road, Bei-tou district, Taipei, Taiwan, ROC

    Chieh-Yu Liu & Hui-Chun Chen

Authors
  1. Chieh-Yu Liu
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  2. Hui-Chun Chen
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Correspondence to Chieh-Yu Liu.

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Funding

This study was sponsored by Pfizer (Taiwan), grant number DN-PC-100-015.

Conflict of interest

Neither of the authors is an employee of Pfizer (Taiwan). Chieh-Yu Liu is a full-time associate professor in the Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences, and has received research grants from Pfizer Taiwan Inc. Hui-Chun Chen is a graduate student in the Department of Nursing, National Taipei University of Nursing and Health Sciences.

Ethical approval

Due to the nature of secondary data analysis and using previously collected and anonymous data, all data analysis procedures conducted in this paper were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and this study was classified as being in the Exempt Review category.

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Liu, CY., Chen, HC. Cost-Effectiveness Analysis of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation in Taiwan. Clin Drug Investig 37, 285–293 (2017). https://doi.org/10.1007/s40261-016-0487-7

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