PCV85 - Cost Effectiveness Of Apixaban Comapred To Aspirin In Patients With Atrial Fibrillation

Abstract

To determine the cost-effectiveness of apixaban compared to aspirin to prevent thromboembolic events in patients with atrial fibrillation who are unsuitable or intolerant of warfarin therapy, from an Australian health care perspective. By extrapolating data from the Apixaban Versus Acetylsalicylic acid to prevent Stroke in Atrial Fibrillation (AVERROSE) trial, a Markov model with yearly cycles was developed to simulate the costs and effects of apixaban compared to aspirin over 10 years. The model comprised five health states: ‘Alive without thromboembolic disease (stroke, myocardial infarction and other systemic embolism) nor major bleeding (MB)’; ‘Alive with thromboembolic disease, but without prior MB’; ‘ Alive without thromboembolic disease, but with prior MB’; ‘Alive with thromboembolic disease and prior MB’; and ‘Dead’. Costs, from an Australian health care perspective, were estimated from published sources. The main outcome of interest was incremental cost-effectiveness ratio (ICER) per quality adjusted life year (QALY) saved and per year of life saved (YoLS). Costs and benefits were discounted at 5.0% per annum. For each patient followed-up over 10 years, the model predicted that compared to aspirin, apixaban would lead to 0.19 YoLS (discounted) and 0.20 QALYs saved (discounted), at a net cost of AUD $5,025 (discounted). This equated to ICERs of AUD $27,090 per YoLS and AUD $25,095 per QALY saved. One way and probabilistic sensitivity analyses indicated the results to be robust. Compared to aspirin, apixaban is likely to be cost-effective in preventing thromboembolic disease among patients with atrial fibrillation who are intolerant to warfarin.