Chicago, IL—A cost analysis comparing the use of apixaban (Eliquis) and aspirin in patients with atrial fibrillation (AF) shows a net reduction in total medical costs with apixaban, based on data from the AVERROES (Apixaban versus Acetyl salicylic Acid to Prevent Strokes) trial, said Alpesh N. Amin, MD, MBA, FACP, Associate Professor of Medicine, Executive Director, Hospitalist Program, University of California, Irvine School of Medicine, at the 2012 American College of Cardiology meeting.
The multicenter, multinational, double-blind AVERROES trial compared the new oral anticoagulant apixaban (which is approved in Europe but not yet in the United States) with aspirin in 5559 patients with AF and at least 1 other stroke risk factor who were unable or unwilling to take warfarin (Coumadin).
In 42% of the patients, the international normalized ratio could not be maintained within the required therapeutic range with warfarin use. This trial was terminated early, because of the superior benefit with apixaban for the primary end point of stroke or systemic embolism event. A total of 51 events occurred with apixaban compared with 113 with aspirin (hazard ratio for apixaban, 0.45). However, major bleeding events were more common with apixaban than with aspirin.
Dr Amin and colleagues calculated the costs of apixaban or aspirin based on the rates of primary, secondary, and safety end points in the trial and their associated cost. Compared with aspirin, apixaban was associated with a $655 per patient-year reduction in total medical costs. The largest reduction ($546) was for the cost associated with an ischemic stroke. Other reductions were $51 for hemorrhagic stroke, $77 for myocardial infarction, and $55 for systemic embolism. However, the cost for bleeding increased by $75 with apixaban.
The estimated total cost reduction with apixaban compared with aspirin were consistent across sensitivity analyses and models with varying clinical event rates and associated costs.
“These results serve to start and further the discussion at a hospital system level about which of the new anticoagulants should be included in their formulary, and how AF will be managed overall,” said Dr Amin.
“Also, hospitals and physician groups across the United States are working toward the so-called ‘triple aim’ of the Centers for Medicare & Medicaid Services: improved resource utilization, quality, and service. In this regard, the new oral anticoagulants improve resource utilization, as they are more cost-effective across the board, potentially providing better quality, because they have better efficacy outcomes, with a similar safety profile that contributes to patient service.”—MM