OBJECTIVES: A recent observational study among patients with nonvalvular atrial fibrillation (NVAF) showed switching from apixaban to rivaroxaban was associated with a higher risk of stroke/systemic embolism (SE) and major bleeding (MB) compared to continuing apixaban. However, there is limited evidence on the economic outcomes associated with switching from apixaban to rivaroxaban. We aimed to compare the cost of clinical events among NVAF patients in the United States (US) in two scenarios: the first scenario involved treatment-eligible patients receiving apixaban (the ‘continuers’) and the second scenario assumed all patients receiving apixaban switch to rivaroxaban (the ‘switchers’).

METHODS: A decision analytic model was developed to evaluate the incidence and cost of stroke/SE (composite of ischemic stroke, hemorrhagic stroke, and SE) and MB (composite of gastrointestinal bleeding, intracranial hemorrhage, and other MB) under each scenario. The analysis was conducted over a 1-year time horizon from a hypothetical one-million-member Medicare Fee-For-Service plan perspective. Clinical evidence (incidence of clinical events and hazard ratios for ‘switcher’ vs. ‘continuer’ patients) was sourced from a published real-world evidence study. Epidemiology inputs were sourced from published literature. The costs of clinical events were sourced from Diagnostic-Related Groups and Medical Expenditure Panel Survey data (2023 US dollar value). The incremental cost of clinical events was estimated based on the difference between the ‘switchers’ and ‘continuers’ scenarios.

RESULTS: After applying the eligibility criteria, 48,838 patients with prevalent NVAF were identified to be currently receiving apixaban. Switching these 48,838 patients from apixaban to rivaroxaban was associated with an additional 381 stroke/SE and 1,044 MB events, resulting in an estimated $17.9 million annual incremental costs (incremental costs of $30.58 per patient per month and $1.49 per member per month).

CONCLUSIONS: Switching from apixaban to rivaroxaban among patients with NVAF was associated with a substantial increase in clinical event-related costs for US payers.