Cost-effectiveness Analysis of Pharmacogenomics (PGx) based Warfarin, Apixaban and Rivaroxaban compared to Standard Warfarin for Atrial Fibrillation Patients in Canada
Abstract
This study assessed cost-effectiveness of pharmacogenomics (PGx)-based warfarin, apixaban and rivaroxaban compared to standard warfarin therapy for atrial fibrillation (AF) patients in Canada. A decision-analytic Markov model was developed to compare lifetime costs and quality-adjusted life years (QALYs) from the public healthcare payer perspective. The parameters applied in the model were derived from published literature and some costs from the IC/ES databases. The results were summarized in terms of the incremental cost-effectiveness ratio (ICER). Compared to standard warfarin, PGx-based warfarin care had an ICER of 17,727/QALY and apixaban had an ICER of $64,853/QALY gained. Apixaban dominated rivaroxaban. The probabilistic sensitivity analysis showed that apixaban, rivaroxaban, PGx-based warfarin and standard warfarin were cost-effective at some willingness-to-pay (WTP) thresholds. Specifically, PGxbased warfarin therapy had a higher probability of being cost-effective than apixaban (51.5% vs 14.1%) at a WTP threshold of $50,000/QALY. At a WTP threshold of $150,000/QALY, apixaban had a higher probability of being cost-effective than PGxbased warfarin (70.1% vs 5.7%). We found that apixaban offers the best balance between efficacy and safety and has a high probability of being cost-effective for AF patients in Canada at a WTP threshold of $150,000/QALY.