OBJECTIVES: A recent US 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 Germany 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 German public healthcare payer perspective. Clinical evidence (incidence of clinical events; hazard ratios for ‘switcher’ vs. ‘continuer’ patients) was sourced from a published real-world study. Epidemiology inputs were sourced from published literature. Clinical event costs were sourced from published literature and public cost databases (2023 Euro values). The incremental cost of clinical events was estimated based on the difference between the ‘switchers’ and ‘continuers’ patients.

RESULTS: In 70.1 million German adults, 1.05 million prevalent NVAF patients were identified to be currently receiving apixaban after applying the eligibility criteria. Switching these 1.05 million patients from apixaban to rivaroxaban was associated with an additional 8,249 stroke/SE and 22,165 MB events, which resulted in an estimated €159 million annual incremental cost (incremental costs of €19.59 per patient per month and €0.30 per person per month).

CONCLUSIONS: Switching from apixaban to rivaroxaban among patients with NVAF was associated with a substantial increase in clinical event-related costs for the German public healthcare payer.