Cost-effectiveness of Rivaroxaban versus Warfarin for Stroke Prevention in Atrial Fibrillation: A Systematic Review and Economic Evaluation
Authors: Y. Zhang, L. Wang, H. Li, J. Chen, X. Liu
Background: Atrial fibrillation (AF) is a major risk factor for stroke, and anticoagulation therapy is essential for stroke prevention. Rivaroxaban, a direct oral anticoagulant, has been compared with warfarin in terms of efficacy and safety, but its cost-effectiveness remains debated. Objective: This study aimed to systematically review and evaluate the cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in AF patients from a healthcare perspective. Methods: We conducted a systematic review of economic evaluations comparing rivaroxaban with warfarin in AF. A Markov model was developed to simulate the lifetime costs and quality-adjusted life years (QALYs) for a hypothetical cohort of AF patients. Model inputs were derived from published literature and meta-analyses. One-way and probabilistic sensitivity analyses were performed. Results: The base-case analysis showed that rivaroxaban was associated with an incremental cost of $12,000 and an incremental QALY gain of 0.15, resulting in an incremental cost-effectiveness ratio (ICER) of $80,000 per QALY gained. At a willingness-to-pay threshold of $100,000 per QALY, rivaroxaban had a 65% probability of being cost-effective. Sensitivity analyses indicated that the results were most sensitive to the cost of rivaroxaban and the risk of intracranial hemorrhage. Conclusions: Rivaroxaban may be a cost-effective alternative to warfarin for stroke prevention in AF patients, particularly when the willingness-to-pay threshold is high. However, the cost-effectiveness is sensitive to drug pricing and bleeding risk. Further research is needed to confirm these findings in different healthcare settings.
