OBJECTIVES: Apixaban has been shown to be effective in reducing the risk of stroke and major bleeding events in patients with non-valvular atrial fibrillation (NVAF). The objective of this study was to estimate the consumer value (defined as the monetary value of benefits gained) and surplus of apixaban compared with warfarin and rivaroxaban in patients with NVAF.

METHODS: A trial comparing apixaban with warfarin and an independent observational study comparing apixaban with rivaroxaban were used to estimate consumer value based on averting stroke, major bleeding events and all-cause death. The value per event avoided was calculated from the observed risk reduction and the cost of events, as well as the monetary value of the lower all-cause mortality risk. Consumer surplus was estimated by subtracting incremental treatment cost from consumer value.

RESULTS: The consumer value of treating 100,000 patients with apixaban instead of warfarin over 1 year exceeds $5.5 billion. Most value is accrued via mortality risk reduction, estimated at $5.25 billion, with additional savings from fewer strokes and reduced monitoring costs, estimated at $257 million. Total consumer surplus per 100,000 patients treated with apixaban instead of warfarin over 1 year is estimated to exceed $4.9 billion. Similarly, the consumer value of treating 100,000 patients with apixaban instead of rivaroxaban for 1 year is estimated to exceed $3.9 billion, comprised of $3.88 billion due to mortality risk reduction and $39 million due to fewer strokes and major bleeding events. Total consumer surplus per 100,000 patients treated with apixaban instead of rivaroxaban over 1 year is estimated to exceed $3.3 billion.

CONCLUSIONS: Apixaban is a valuable treatment option for patients with NVAF, providing significant consumer value and surplus compared with warfarin and rivaroxaban. Results indicate that the use of apixaban generates substantial value to patients with NVAF in the US.