Background: This study compares the total medical costs with the use of the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban vs. warfarin in the US, based on the results of the ARISTOTLE, RE-LY and ROCKET-AF trials. Methods: A cost comparison analysis was conducted from the US perspective. The rates of efficacy and safety endpoints for warfarin were estimated as the weighted averages from the ARISTOTLE, RE-LY and ROCKET-AF trials. The rates of clinical events for NOACs were calculated using the hazard ratios from the original trials. Annual incremental costs associated with clinical events from the US payer perspective were obtained from published literature and inflation adjusted to 2010 cost. Total medical cost avoidance was evaluated for each NOAC vs. warfarin. Results: Based on data from ARISTOTLE, RE-LY and ROCKET-AF, the per patient year event rates for warfarin treatment were estimated to be 1.24% for ischemic or uncertain type of stroke (IS), 0.75% for myocardial infarction (MI), and 2.83% for major bleeding excluding hemorrhagic stroke (MB). The estimated event rates were IS: 1.14% [CI: 0.92-1.40], 0.94% [CI: 0.74-1.22] and 1.17% [CI: 0.93-1.45]; MI: 0.66% [CI: 0.50-0.88], 1.04% [CI: 0.75-1.43] and 0.61% [CI: 0.47-0.80]; MB: 2.03% [CI: 1.81-2.28], 2.92% [CI: 2.58-3.28] and 3.14% [CI: 2.78-3.51] per patient year for apixaban, dabigatran and rivaroxaban, respectively. 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 MB ($223) and hemorrhagic stroke ($110), with smaller contributions from MI ($55) and IS ($32); for dabigatran, cost avoidance came from reductions in hemorrhagic stroke ($166) and IS ($97), but with increased costs from MI ($175) and MB ($26). For rivaroxaban, cost avoidance came from hemorrhagic stroke ($92) and MI ($88), but with increased costs from MB ($87). Conclusions: Compared to warfarin, NOACs were associated with reduction of total medical costs. The largest avoidance of medical costs was driven by decreased event rates of bleeding and stroke.
Deitelzweig, S., Amin, A., Jing, Y., Makenbaeva, D., Makenbaeva, D., Wiederkehr, D., … Graham, J. (2012). COMPARISON OF TOTAL MEDICAL COST AVOIDANCE WITH THE USAGE OF NEW ORAL ANTICOAGULANTS INSTEAD OF WARFARIN AMONG ATRIAL FIBRILLATION PATIENTS, BASED ON THE ARISTOTLE, RE-LY AND ROCKET-AF TRIALS. Journal of the American College of Cardiology, 59(13), E599. https://doi.org/10.1016/s0735-1097(12)60600-7