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Clinical Articles, News & Views

New oral anticoagulants eclipse warfarin in cost savings

Usage of the new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, may be associated with lower medical costs (excluding drug costs) relative to warfarin, according to results from the RE-LY, ROCKET-AF, and ARISTOTLE clinical trials. These were presented at the American College of Cardiology’s (ACC’s) 61st Annual Scientific Session, held recently in Chicago.

The study aimed to evaluate the medical cost reductions associated with the use of individual NOACs instead of warfarin from the US payer perspective.  Rates for efficacy and safety clinical events for warfarin were estimated as the weighted averages from the RE-LY, ROCKET-AF and ARISTOTLE trials, and the rates of clinical events for NOACs were calculated using the hazard ratios from the original trials.

Incremental medical costs to a US health payer of an AF patient experiencing a clinical event during one year following the event were obtained from published literature and inflation adjusted to 2010 cost levels. Medical costs, excluding drug costs, were evaluated and compared for each NOAC vs warfarin. Sensitivity analyses were conducted to determine the influence of variations in clinical event rates and incremental costs on the medical cost reduction.

Per patient year, the total medical cost reduction associated with NOAC use instead of warfarin was estimated to be $439, $62, and $133 for apixaban, dabigatran and rivaroxaban, respectively. For apixaban, cost avoidance was driven by the reduction in major bleeding ($223) and haemorrhagic stroke ($110), with smaller contributions from myocardial infarction ($55) and ischaemic or uncertain type of stroke (IS) ($32); for dabigatran, cost avoidance came from reductions in haemorrhagic stroke ($166) and IS ($97), but with increased costs from MI ($175) and major bleeding ($26). For rivaroxaban, cost avoidance came from haemorrhagic stroke ($92) and MI ($88), but with increased costs from major bleeding ($87).


1 Deitelzweig S, Amin A, Jing Y, Makenbaeva D, Wiederkehr D, Lin J, Graham J.  Medical cost reductions associated with the usage of novel oral anticoagulants vs warfarin among atrial fibrillation patients, based on the RE-LY, ROCKET-AF, and ARISTOTLE trials. Journal of Medical Economics 2012;Print: Pages 1–10. doi:10.3111/13696998.2012.680555

Published on: April 18, 2012

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    None Found


  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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