Cost Effectiveness of Rivaroxaban versus Warfarin to Pre-vent Stroke in Iranian Atrial Fibrillation Patients

Atrial fibrillation (AF) is the most common sustained arrhyth-mia in adults which need anti-coagulant to prevent stroke. Due to high cost of Rivar-oxaban compared to Warfarin, it is not prescribed as much as Warfarin by physicians despite its superiority in intracranial hemorrhage. This study aimed to evaluate the cost-effectiveness of Rivaroxaban versus Warfarin in preventing stroke in AF patients.

This study is a cost-utility analysis with cost-effectiveness as-sessed by the incremental cost per quality-adjusted life-year (QALY). Two strategies were used to obtain the costs; the first was from available resources, and the next was to collect data using a questionnaire. A total number of 98 patients who met the inclusion criteria had answered the questionnaire. Utility values for obtaining ∆QALYs originated from published data. Finally the cost-effectiveness of Warfarin versus Rivar-oxaban was assessed using an incremental cost-effectiveness ratio (ICER), which was calculated as the incremental cost per QALY gained.

Mean annually physician visits were 4 times in Rivaroxaban and 14 times in Warfarin group. The patients in Warfarin Group checked their INR (international nor-malized ratio) 15 times a year, while the patients in Rivaroxaban group did not check at all. The wasting time for each physician visit and doing Lab test was approximately 3 hours. Total cost of Rivaroxaban in both private (16,699,000 IRR) and governmen-tal sector (15,755,000 IRR) were less than that for Warfarin; governmental sector 24, 233,700 & 20,345,600 IRR respectively. We analyzed the ΔQALYs of 7 different arti-cles in which the mean ΔQALY was 0.21 (Variance: 0.0072). The incremental cost per QALY per patient for Warfarin in private versus governmental sector was 18,514,762 Rial /QALY, while the ICER between Rivaroxaban versus Warfarin in both private and governmental sectors was negative (-35,879,523.8 and -21,860,000 Rial/QALY). So the calculated threshold based on the per capita gross national product (GDP), which was 702,576,000 Rials (calculated at 42,000IRR/$), showed that Rivaroxaban is more cost-effective than Warfarin.

Use of Rivaroxaban versus Warfarin in both governmental and private sectors is a cost-effective choice. So, due to its economic and potential benefits, it is recommended to prescribe Rivaroxaban rather than Warfarin.