Cost-effectiveness of rivaroxaban compared to warfarin for stroke prevention in atrial fibrillation

Hyunmee Kim, Hyeongsoo Kim, Seong Kyung Cho, Jin Bae Kim, Boyoung Joung, Changsoo Kim

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background and Objectives: Rivaroxaban is noninferior to warfarin for preventing stroke or systemic embolism in patients with high-risk atrial fibrillation (AF) and is associated with a lower rate of intracranial hemorrhage (ICH). We assessed the cost-effectiveness of rivaroxaban compared to adjusted-dose warfarin for the prevention of stroke in patients with nonvalvular AF. Methods: We built a Markov model using the Korean Health Insurance Review & Assessment Service database. The base-case analysis assumed a cohort of patients with prevalent AF who were aged 18 years or older without contraindications to anticoagulation. Results: Number of patients with CHA 2 DS 2 -VASc scores 0, 1 and ≥2 were 56 (0.2%), 1,944 (6.3%) and 28,650 (93.5%), respectively. In patients with CHA 2 DS 2 -VASc scores ≥2, the incidence rate of ischemic stroke was 3.11% and 3.76% in warfarin and rivaroxaban groups, respectively. The incidence rates of ICH were 0.42% and 0.15%, and those of gastrointestinal bleeding were 0.32% and 0.15% in warfarin and rivaroxaban, respectively. Patients with AF treated with rivaroxaban lived an average of 11.8 quality-adjusted life years (QALYs) at a lifetime treatment cost of $20,886. Those receiving warfarin lived an average of 11.4 QALYs and incurred costs of $17,151. Patients with rivaroxaban gained an additional 0.4 QALYs over a lifetime with an additional cost of $3,735, resulting in an incremental cost-effectiveness ratio of $9,707 per QALY. Conclusions: Patients who had been treated with rivaroxaban may be a cost-effective alternative to warfarin for stroke prevention in Korean patients with AF.

Original languageEnglish
Pages (from-to)252-263
Number of pages12
JournalKorean Circulation Journal
Volume49
Issue number3
DOIs
Publication statusPublished - 2019

Bibliographical note

Funding Information:
This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology, and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HC15C1200).

Publisher Copyright:
Copyright © 2019. The Korean Society of Cardiology

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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