Cost-effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China


Abstract

Background and objective: To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF).

Methods: The Markov model was constructed to compare patients'' quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3-6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study.

Results: The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least.

Conclusions: In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

Keywords: Chinese population; Cost‐effectiveness; New oral anticoagulants; Warfarin.

Conflict of interest statement

All author declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Representation of the Markov model. The four treatment options are shown on the left. “M”represents a Markov process with 4? health states. These health states are identical for each treatment option. “Min” represent state without incident or sequelae, “Mod” represent moderate disabilities, “Sev” represent completely disabilities , Die means death. All patients remain in the “Min”state until one of the five events occurs. NVAF, nonvalvular atrial fibrillation; IS, ischemic stroke; ICH, intracranial hemorrhage; ECH, extracranial hemorrhage; MI, myocardial infarction
Fig. 2
Fig. 2
Tornado analysis (ICER).?Cost per additional quality-adjusted life year (bars) of rivaroxaban compared to adjusted-dose warfarin as determined in tornado diagram over plausible ranges for all variables. The willingness-to-pay threshold of 202295.67 yuan per quality-adjusted life year are presented.
Fig. 3
Fig. 3
Cost-effectiveness acceptance curve.?Cost-effectiveness acceptability curve results based on 1000 Monte Carlo simulations of the model. The curve presents the probability that the rivaroxaban regimen is cost-effective as a function of willingness-to-pay threshold
Fig. 4
Fig. 4
Incremental Cost-Effectiveness Rate scatter.?Incremental cost-effectiveness scatterplot of the result of the probabilistic sensitivity analysis. Each point represents a simulation. Ellipse represents 95% confidence interval ellipse
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