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Clinical Articles, Lead Article

Apixaban cost-effective in stroke prevention

Based on randomised trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in vitamin K antagonists (VKA) suitable and VKA unsuitable patients with AF, respectively, according to a recent study.1

A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalisation and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model.

Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime.

The estimated incremental cost-effectiveness ratio was £11,909 and £7,196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs.

Cost-effectiveness of apixaban 2

Dr Paul Dorian (University of Toronto, Canada)

Speaking to BJC Arrhythmia Watch, co-author Dr Paul Dorian (University of Toronto, Canada) said: “Compared to warfarin or aspirin (in warfarin unsuitable patients), apixaban is a cost-effective alternative. Less bleeding (versus warfarin) and fewer strokes (versus both warfarin and aspirin) result in fewer costs from treating complications. However, apixaban costs more that the other drugs, and importantly patients on the average live longer with apixaban, therefore incurring more costs over a lifetime. Cost-effectiveness studies should consider not only all costs but the source of the costs, as well the specific benefits”.


1. Dorian P, Kongnakorn T, Phatak H, et al. Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation. Euro Heart J 2014;35:1897–906.

Published on: August 5, 2014

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