Europace. 2025 Aug 31:euaf195. doi: 10.1093/europace/euaf195. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Apixaban was superior to aspirin for the prevention of stroke or systemic embolism in participants with subclinical atrial fibrillation (SCAF) in the Apixaban for the Reduction of Thrombo-Embolism in Patients with Subclinical Atrial Fibrillation (ARTESiA) trial. This was especially true for those with CHA2DS2-VASc score >4. Understanding the cost-effectiveness of treating SCAF is important for decision makers.
METHODS: Canadian, UK, German and US direct healthcare costs (in 2023 USD) were applied to hospitalized events (including strokes and bleeds) and study drugs for all participants with a CHA2DS2-VASc score >4 to determine the mean cost per participant during the trial (mean follow-up 3.5 years). A daily cost of $0.63, $0.11, $2.26, and $6.06 for apixaban in Canada, UK, Germany and the US was used. If in-trial results were not cost-saving (below $0), the prospective plan was to perform a lifetime cost-effectiveness analysis using a Markov model and a willingness-to-pay of 50,000 USD per Quality Adjust Life-Year (QALY).
RESULTS: After considering the cost of study medication and clinical events over 3.5 years, apixaban was dominant (cost-saving and more effective) in Canada (-$2,301) and the UK (-$902) but cost more in Germany and the US ($600 and $1,990 respectively). Over a lifetime, treatment with apixaban produced a net gain of 0.107 QALYs, but with costs in both Germany ($2,623 more) and the US ($9,110 more); yielding an incremental cost effectiveness ratio of $24,514 per QALY for Germany and $85,140 for the US.
CONCLUSION: In patients with SCAF and a CHA2DS2-VASc score >4, apixaban is cost-saving in Canada and the UK and cost-effective in Germany. Apixaban was not cost-effective in the US under the base cost assumption but would be cost-effective at a daily cost of $4.35, and cost saving at $3.59.
PMID:40886070 | DOI:10.1093/europace/euaf195