Abstract 257: A Long-Term Comparison of Clinical and Economic Outcomes with Novel Oral Anti- Coagulants

Objectives: Patients with non-valvular atrial fibrillation (NVAF) are routinely prescribed anticoagulants to prevent stroke. Traditional anticoagulants like warfarin are less expensive and less effective at preventing stroke than some novel oral anti-coagulants (NOACs). This study uses a widely published microsimulation model to compare population-wide outcomes associated with alternative approaches to preventing stroke among NVAF patients. Methods: The Health Economics Medical Innovation Simulation (THEMIS) was used to analyze clinical and economic outcomes among a representative sample of Americans age 51+. The lifetime evolution of disease and functional status was modeled for each individual under four scenarios: status quo using current NVAF treatment patterns, and three scenarios where NVAF patients are treated with apixaban, dabigatran, or rivaroxaban, respectively. Markov state transition probabilities were derived from the Health and Retirement Study; published cost estimates for stroke and other adverse events were used. NOAC prices were assumed to fall by 80% at patent expiration. The number of stroke-free years, bleeds and total medical expenditures were calculated for the entire population through 2062. Findings: Over 50 years, the three NOAC scenarios resulted in 28-31 million more stroke-free years and higher total medical expenditures compared to the status quo. Among NOACs, apixaban and dabigatran resulted in similar stroke outcomes, but apixaban had 1.4 million fewer bleeds and $6.9 billion lower total medical expenditures compared to dabigatran across the age 51+ population. Rivaroxaban resulted in higher stroke incidence, more major bleeds and higher total medical expenditures than the other two NOACs. Conclusions: While using NOACs in NVAF treatment raises drug costs compared to current practice, it also reduces stroke incidence. Among NOACs, apixaban does so at lower cost, with fewer bleeding events than either dabigatran or rivaroxaban.