OBJECTIVES: A recently published observational study, for the management of non-valvular atrial fibrillation (NVAF), suggests that switching from apixaban to rivaroxaban may be associated with higher risk for unfavorable outcomes. There is a lack of evidence regarding the economic impact of direct oral anticoagulant (DOAC) switching vs treatment-continuation, we aim to assess the annual cost for the management of clinical events (stroke, systemic embolism (SE) and major bleeding) in patients with NVAF, who continued on apixaban or switched from apixaban to rivaroxaban and vice versa, in Greece.

METHODS: A decision analytic model with a one-year time horizon was developed to estimate the cost from the payer perspective in Greece. The potential risk for DOACs-related clinical outcomes were stroke, SE, and major bleedings. These DOAC-related clinical outcomes were modeled using results from a retrospective observational study in the USA. Directly reimbursed costs, adjusted for inflation, in Greece were obtained from published literature. Epidemiological data (number of AF patients receiving rivaroxaban and apixaban) in Greece were extracted from a local database.

RESULTS: The analysis indicated that patients who initiated and continued on apixaban, compared to patients who switched from apixaban-to-rivaroxaban, could potentially prevent 166 clinical outcomes resulting in annual cost-savings of €556,692 for the public payer. Additionally, patients who switched from rivaroxaban-to-apixaban, compared to patients who continued the treatment with rivaroxaban, could potentially prevent 146 clinical outcomes, resulting in annual cost-savings of €331,708 for public payer.

CONCLUSIONS: The present study concluded that, patients continuing treatment with apixaban had reduced clinical outcomes compared to those who switched to rivaroxaban and significant savings were estimated for the public payer, since switching from apixaban to rivaroxaban among patients with NVAF was associated with a substantial increase in event-related costs. However, future studies with an extended time horizon are crucial in capturing the long-term outcomes and sustained benefits of interventions.