Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Atrial fibrillation (AF) is a risk factor for thromboembolic complications, requiring administration of vitamin K antagonists (warfarin) or the new oral anticoagulants (apixaban, dabigatran and rivaroxaban).

Aim. To assess the influence of apixaban use on the budget as an alternative to warfarin, dabigatran or rivaroxaban use in patients with non-valvular AF in the Russian Federation (RF).

Material and methods. The analysis was performed with the perspective of the health care budget with 5 year horizon period and by the pharmacoeconomic model developed by Pharmerit International (Rotterdam, Netherlands) and adapted for the RF. The cardiovascular complications rate in the model was in line with the results of comparative clinical trials: ARISTOTLE, AVERROES, RE-LY, ROCKET-AF. The analysis suggested that 100% of patients with atrial fibrillation were transferred on apixaban instead of warfarin, dabigatran or rivaroxaban. The analysis was based on the assumption that patients were fully committed to the therapy over the horizon of the study, ie, refusal of treatment was not considered. The possibility of episodes of ischemic and hemorrhagic strokes, the severity of which corresponded to previously published data for the Russian population, was considered in the study. The present study was performed based on two scenarios. In the first of them the cost of anticoagulation therapy was determined on the basis of the average weighted prices of public procurement for the period from 04.01.2014 to 01.04.2015. The alternative scenario purported to demonstrate potential savings of the budget of the health care system on the inclusion of apixaban in the list of essential drugs. This scenario took into account that the cost of dabigatran and rivaroxaban corresponded to registered maximum selling price including 10% VAT and 10% of the wholesale allowance and the cost of apixaban - presumed maximum selling price which the producer intends to register in case the drug is included in the essential drugs list, subject to 10% VAT and 10% wholesale mark. The cost of complications treatment corresponded to the rate of compulsory health insurance for the city of St. Petersburg for 2015.

Results. The estimated number of patients with non-valvular AF who require anticoagulation therapy in the RF is 1,196,600 people according to the epidemiological data. Treatment with apixaban significantly reduces the incidence of cardiovascular events as compared with warfarin and rivaroxaban. The results of the budget impact analysis, taking into account the price obtained at auction from 01.04.14 through 01.04.15, show a decrease in the load on the budget when the apixaban is included in the therapy regimen of non-valvular atrial fibrillation. Potential savings of resources of the health care system reached 10.9 billion rubles as compared with dabigatran and 39.2 billion rubles as compared with rivaroxaban. This advantage can be explained by both the lower cost of apixaban in comparison with reference drugs, and a reduction of the in-hospital expenses on complications treatment. Switching from warfarin to apixaban increases the budget load in 2.81 times. However, previous data demonstrate the economic feasibility of the additional costs of apixaban, that help to achieve significant advantages from a clinical point of view. The results obtained on the basis of prices, intended to include apixaban in the list of essential drugs, showed that in this case the savings of the budget of the health care system will reach 127-129 bln. rubles for 5 years (average 26%) as compared with dabigatran and rivaroxaban. The comparison of apixaban with warfarin showed an increase in total costs of therapy in 2.72 times.

Conclusion. The inclusion of apixaban in the therapy regimen of non-valvular atrial fibrillation can significantly reduce the burden on the budget of the health care system as compared with dabigatran and rivaroxaban, as well as reduce the incidence of cardiovascular events compared with warfarin. This allows recommending the inclusion of the drug in the federal and regional programs for the prevention of thromboembolic complications in this group of patients.

About the Author

A. V. Rudakova
St. Petersburg State Chemical Pharmaceutical Academy
Russian Federation
Professora Popova ul. 14, St. Petersburg, 197376 Russia


1. National guidelines for the diagnosis and treatment of atrial fibrillation (2012). Available at: Acccessed by 18.04.2015. Russian (Национальные рекомендации по диагностике и лечению фибрилляции предсердий (2012). Доступно на Проверено 18.04.2015).

2. Wilke T., Groth A., Mueller S., et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 2013; 15: 486 - 93.

3. Gallagher A.M., Rietbrock S., Plumb J., van Staa T.P. Initiation and persistence of warfarin or aspirin in patients with chronic atrial fibrillation in general practice: do the appropriate patients receive stroke prophylaxis? J Thromb Haemost 2008; 6 (9):1500-6.

4. Lyman G.H. Comparative Effectiveness Research in Oncology. The Oncologist 2013; 18: 752-9.

5. Soria J.C., Blay J., Spano J., et al. Added value of molecular targeted agents in oncology. Ann Onc 2011; 22: 1703 - 16.

6. Sullivan S., Mauskopf J., Augustovski F., et al. Budget ImpactAnalysis—Principles of GoodPractice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice IITask Force. Value in health 2014; 17(1): 5-14.

7. Granger C.B., Alexander J.H., McMurray J.J., et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365(11):981-92.

8. Connolly S.J., Eikelboom J., Joyner C., et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011;364(9):806-17.

9. Connolly S.J., Ezekowitz M.D., Yusuf S., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361(12):1139-151.

10. Patel M.R., Mahaffey K.W., Garg J., et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365(10):883-91.

11. Mitchell S.A Simon T Raza S et al., The efficacy and safety of oral anticoagulants in warfarin-suitable patients with nonvalvular atrial fibrillation: systematic review and meta-analysis. Clin Appl Thromb Hemost 2013;19(6): 619-31.

12. Rudakova A.V., Parfenov V.A. Pharmacoeconomic aspects of prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation: the use of apixaban compared with warfarin and aspirin. Rational Pharmacotherapy in Cardiology 2014; 10 (3): 275-82. Russian (Рудакова А.В., Парфенов В.А. Фармакоэкономические аспекты профилактики инсульта и системной тромбоэмболии у пациентов с неклапанной фибрилляцией предсердий: применение апиксабана по сравнению с варфарином и ацетилсалициловой кислотой. Рациональная Фармакотерапия в Кардиологии 2014; 10 (3): 275-82).

13. Wolowacz S., Samuel M., Brennan V., et al. The cost of illness of atrial fibrillation: a systematic review of the recent literature. Europace 2011; 13: 1375–85.

14. Karpov Yu.A. Apixaban new possibilities for prevention of complications in patients with atrial fibrillation. Atmosphere. News of Cardiology 2013; 4: 2-8. Russian (Карпов Ю.А. Апиксабан: новые возможностипрофилактики осложнений у больныхс фибрилляцией предсердий. Атмосфера. Новости кардиологии 2013; 4: 2-8).


For citations:


Views: 844

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)