Table 3.
Selected economic evaluations of anticoagulation for stroke prevention in atrial fibrillation.
| Study (Year) | Patient population | Analysis/Methodology | Country | Intervention vs. Comparator | Time Horizon | Currency | Incremental Cost Effectiveness Ratio | Reference |
|---|---|---|---|---|---|---|---|---|
| Freeman (2011) | Patients aged 65 years or older with nonvalvular AF and risk factors for stroke (CHADS2 score ≥1) and no contraindications to anticoagulation. | CUA/Markov model | United Kingdom | High-dose (150 mg bid) or low-dose (100 mg bid) dabigatran vs. warfarin | Lifetime | 2008 US$ | $45,372/QALY (High Dose Dabigatran) $51,229/QALY (Low Dose Dabigatran) |
(51) |
| Kleintjens (2013) | Patients with non-valvular AF at moderate to high risk of stroke (CHADS2 score ≥2) | CUA/Markov model | Belgium | rivaroxaban vs. warfarin | Lifetime | 2010 Euros | €7,493/LY €8,809/QALY |
(54) |
| Canestaro (2013) | Patients 70 years or older with atrial fibrillation | CUA/Markov model | United States | dabigatran vs. rivaroxaban vs. apixaban vs. warfarin | Lifetime | 2011 USD | Compared to warfarin: $93,063/QALY (apixaban) $111,465/QALY (rivaroxaban) $140,557/QALY (dabigatran) |
(55) |
| You (2014) | Patients with AF at risk of stroke (CHADS2 scores ≥2) | CUA/Markov model | United States | DOACs (apixaban, dabigatran and rivaroxaban) vs. warfarin [stratified by time in therapeutic range (TTR)] | Lifetime | 2013 USD | $35,804/QALY (60% TTR) $60,141/QALY (70% TTR) $79,268/QALY (75% TTR) |
(56) |
| Shah (2016) | Patients with AF at risk of stroke | CUA/Markov model | United States | dabigatran vs. rivaroxaban vs. apixaban vs. edoxaban vs. warfarin | Lifetime | 2015 USD | Compared to warfarin: $25,816/QALY (apixaban) $27,643/QALY (edoxaban) $57,434/QALY (rivaroxaban) $31,435/QALY (dabigatran) |
(57) |
| Cowper (2017) | Patients with AF and 1 or more additional risk factors for stroke | CUA/Trial-based | United States | apixaban vs. warfarin | Lifetime | 2014 USD | $53,925/QALY | (58) |
| Wu (2021) | Patients older than 75 years with AF | CUA/Markov model | United States | dabigatran vs. rivaroxaban vs. apixaban vs. edoxaban vs. warfarin | 10 years | 2020 USD | Compared to warfarin: $112,439/QALY (dabigatran) $71,587/QALY (rivaroxaban) $52,800/QALY (apixaban) $15,865/QALY (edoxaban) |
(59) |
AF, atrial fibrillation; CDN, Canadian Dollar; CUA, cost utility analysis; DOAC, direct oral anticoagulant; HF, heart failure; QALY, quality adjusted life years; LY, life years; TTR, time in therapeutic range; USD, US Dollar.