Cost-effectiveness of apixaban in prevention of stroke and systemic embolism in the Czech Republic

Objectives
Apixaban is an oral anticoagulant, direct factor Xa inhibitor. The aim of the analysis was to compare costs and effectiveness of apixaban in the first line prevention of stroke and systemic embolism in vitamin K antagonist (VKA) suitable patients with atrial fibrillation. The analysis was conducted from the perspective of the public healthcare payer in the Czech Republic.
Methods
To assess on cost-utility of apixaban, a Markov model was developed. The analysis was focused on the first line prevention of stroke and systemic embolism in VKA suitable patients suffering from atrial fibrillation with at least one risk factor present (symptomatic heart failure of class II or higher according to NYHA classification, age of 75 years or higher, diabetes mellitus, hypertension). Hazard ratios used in the comparison were obtained from double-blind head-to-head clinical trial ARISTOTLE. Apixaban was compared to used and reimbursed intervention (warfarin) in terms of lifetime costs per quality-adjusted life year. Drug costs, acute care costs, and management costs were assumed.
Results
In the base case scenario, the incremental cost-effectiveness ratio (ICER) of apixaban compared to warfarin reached 18 074 EUR/QALY. QALYs and LYs gained on apixaban treatment were 6.035 and 8,465 whereas patients on warfarin treatment gained only 5.851 and 8,288. Moreover, apixaban prevented the occurrence of most serious events as it reduced the number of strokes by 19 and bleedings by 65 (measured per 1000 patients).
Conclusion
Based on the results apixaban prolongs total survival and improves quality of life of VKA suitable patients with atrial fibrillation. Use of apixaban brought lower risk of serious events. Results indicate apixaban treatment is also very cost-effective as the ICER stays well below willingness to pay threshold.