Cost-effectiveness of apixaban in non-valvular atrial fibrillation (NVAF) based on effectiveness data from a Spanish study in clinical practice (real-world evidence)

To analyze the cost-effectiveness of apixaban in the prevention of stroke in adult patients with non-valvular atrial fibrillation (NVAF), compared to other direct-acting oral anticoagulants (dabigatran, rivaroxaban, edoxaban) and the vitamin K antagonist acenocoumarol, based on data on effectiveness in clinical practice in Spain obtained in the FANTASIIA study. A probabilistic Markov economic model (second-order Monte Carlo simulation) was performed to analyze the costs and utilities (quality-adjusted life years, QALYs) associated with the compared treatments, according to the different probabilities of stroke, major bleeding and death observed in FANTASIIA. The cost per QALY gained in the patient treated with apixaban versus comparators ranged from €2,919 to €7,462. The probability of apixaban being cost-effective ranges from 91.1% (vs dabigatran 150 mg), 97.8% (vs dabigatran 110 mg), and 100% (vs. rivaroxaban, edoxaban, and acenocoumarol). Based on the results of the FANTASIIA study, apixaban is a cost-effective treatment (below a willingness to pay of €25,000 per QALY gained) compared to dabigatran, rivaroxaban, edoxaban, and acenocoumarol in treating patients with NVAF.