Paul E. Nolan

Cost-Effectiveness of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation

Background and Purpose— To estimate the cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation by using novel oral anticoagulants apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg compared with warfarin. Methods— A Markov decision-analysis model was constructed using data from clinical trials to evaluate lifetime costs and quality-adjusted life-years of novel oral anticoagulants compared with warfarin. The modeled population was a hypothetical cohort of 70-year-old patients with nonvalvular atrial fibrillation, increased risk for stroke (CHADS2 ≥1), renal creatinine clearance ≥50 mL/min, and no previous contraindications to anticoagulation. The willingness-to-pay threshold was

Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter.

50 000/quality-adjusted life-years gained. Results— In the base case, warfarin had the lowest cost of

Pharmacokinetics of Sertraline Across Pregnancy and Postpartum

77 813 (SD,

Arizona experience with CardioWest Total Artificial Heart bridge to transplantation.

2223), followed by rivaroxaban 20 mg (

Pharmacokinetic interaction between intravenous phenytoin and amiodarone in healthy volunteers.

78 738±

Amiodarone Prophylaxis for Atrial Fibrillation After Cardiac Surgery: Meta-Analysis of Dose Response and Timing of Initiation

1852), dabigatran 150 mg (

Steady-state interaction between amiodarone and phenytoin in normal subjects☆

82 719±

Effects of Coadministration of Propafenone on the Pharmacokinetics of Digoxin in Healthy Volunteer Subjects

1959), and apixaban 5 mg (

Alternate-day Dosing with Statins

85 326±

Precipitation of Benzodiazepine Withdrawal following Sudden Discontinuation of Midazolam

1512). Apixaban 5 mg had the highest quality-adjusted life-years estimate at 8.47 (SD, 0.06), followed by dabigatran 150 mg (8.41±0.07), rivaroxaban 20 mg (8.26±0.06), and warfarin (7.97±0.04). In a Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost-effective in 45.1%, 40%, 14.9%, 0% of the simulations, respectively. Conclusions— In patients with nonvalvular atrial fibrillation and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg were all cost-effective alternatives to warfarin. The cost-effectiveness of novel oral anticoagulantss was dependent on therapy pricing in the United States and neurological events associated with rivaroxaban 20 mg.