COMPARATIVE PHARMACOECONOMIC ANALYSIS OF RIVAROXABAN AND WARFARIN USAGE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Abstract

Objective: complex pharmacoeconomic evaluation of warfarin replacement with rivaroxaban one of the direct oral anticoagulant (DOAC) for the treatment of patients with non-valvular atrial fibrillation and high risk of thromboembolia with poor international normalized ratio control.Materials and methods: A pharmacoeconomic model was designed to evaluate clinical outcomes of rivaroxaban therapy in compare with warfarin (with poor international normalized ratio control), economic impact was also calculated using budget impact analysis. Direct medical costs included drug costs, inpatient costs and costs of patient rehabilitation with cardiovascular complications. Moreover, indirect costs were simulated, including Gross Domestic Product loss due to disability or mortality of patients. Results were calculated on total number of patients from Russian Federation with non-valvular atrial fibrillation and high risk of thromboembolism, receiving rivaroxaban and warfarin (total of 278,175 patients). Patients with non-valvular atrial fibrillation on other anticoagulant therapies (130,305 patients) were not included in the analysis. Modeling horizon was 12 months.Results: in the analyzed population replacement of warfarin with poor international normalized ratio control with rivaroxaban makes it possible to additionally prevent 3,778 stroke events (-33% in compare with warfarin), 170 events of systemic thromboembolisms (-31%), 1,977 events of fatal bleeding (-11%) and 247 events of myocardial infarctions (-6%). Generally, patients transfer to rivaroxaban therapy reduces mortality by 30% (2,908 cases). Budget impact analysis demonstrated, that despite of the increased drug therapy costs by 2,306.1 million RUR, replacement of warfarin in the part of patients with rivaroxaban reduces costs, related to the complications treatment by 543.0 million RUR, rehabilitation costs - by 461.6 million RUR, INR control costs - by 480.3 million RUR, decline in GDP due to disability and mortality - by 2,988.5 million RUR. Thereby, replacement of patients with poor international normalized ratio control from warfarin to rivaroxaban reduces costs, related to the complications treatment of atrial fibrillation and GDP loss by 2,174.0 million rub.Conclusion: Warfarin replacement with rivaroxaban in patients with non-valvular atrial fi brillation and high risk of thromboembolism with poor international normalized ratio control is the most efficient from clinical and economic points.