• Rivaroxaban is likely cost-effective compared with warfarin for stroke prevention in AF at a willingness-to-pay threshold of $100,000 per QALY.
• The incremental cost-effectiveness ratio (ICER) was $80,000 per QALY gained, with a 65% probability of cost-effectiveness at the threshold.
• Results were most sensitive to the cost of rivaroxaban and the risk of intracranial hemorrhage.
• The findings support the use of rivaroxaban as a cost-effective alternative, but pricing and bleeding risk should be considered in clinical decision-making.