Background: Edoxaban and rivaroxaban for stroke prevention in non-valvular atrial fibrillation (NVAF) patients with CHADS2≥2 have been evaluated in pivotal trials versus warfarin. This study assessed the cost-effectiveness of once-daily edoxaban (60 mg/30 mg dose-reduced) regimen versus rivaroxaban (20 mg/15 mg dose-reduced) for stroke prevention in patients with NVAF patients from a US health plan perspective.
Methods: A Markov model simulated lifetime risk and treatment of stroke, systemic embolism, major bleeding, clinically relevant non-major bleeding, myocardial infarction, and death in NVAF patients treated with edoxaban or rivaroxaban. Efficacy and safety data were from a network meta-analysis using data from patients enrolled in ENGAGE AF-TIMI 48 and ROCKET-AF that were presented previously. 2015 wholesale acquisition cost (WAC) was used for edoxaban and rivaroxaban in the analysis. Healthcare cost and utility data were from published sources. Incremental cost-effectiveness ratios of <$50,000, $50,000-$150,000, and >$150,000 per quality-adjusted life year (QALY) gained were used as thresholds for highly cost-effective, cost-effective, and not cost-effective treatment option per guidance from the AHA/ACC statement on cost/value methodology in clinical practice guidelines and performance measures.
Results: Edoxaban was dominant relative to rivaroxaban, such that it was associated with lower total healthcare cost and better effectiveness in terms of QALYs in the base case analysis (Table). Results were supported by probabilistic sensitivity analyses that showed edoxaban as either dominant or a highly cost-effective alternative (ICER<$50,000) to rivaroxaban 88.4% of the time.
Conclusions: These results showed that once-daily edoxaban (60mg/30mg dose-reduced) regimen is a highly cost-effective treatment relative to rivaroxaban (20mg/15mg dose-reduced) for stroke prevention in NVAF patients.