Plain language summary examining clinical event related costs associated with changing medication from apixaban to rivaroxaban in people with non-valvular atrial fibrillation in the USA and Germany

Plain Language SummaryWhat is this summary about?This study aimed to estimate the costs of stroke/systemic embolism and major bleeding in people with non-valvular atrial fibrillation who started treatment with apixaban and switched to rivaroxaban (vs staying on apixaban). While both apixaban and rivaroxaban are direct oral anticoagulants that prevent blood clots from forming, they behave differently in the body and have differences in their risk profiles (ie, the chance of certain side effects). As there are limited data on the economic impact of these risks and the impact of switching between apixaban and rivaroxaban, this study aimed to provide insight into this area.Clinical events from a published real-world analysis and associated costs were added to a decision model to predict how costs would change if people switched to rivaroxaban (vs staying on apixaban). The model focused on people in the USA and Germany, as both countries have many people with non-valvular atrial fibrillation who are prescribed apixaban or rivaroxaban. The analysis was conducted from the viewpoint of organizations that cover the cost of healthcare. For the US analysis, a theoretical Medicare plan with 1,000,000 members, of whom 47,036 were treated, was used. For the German analysis, the viewpoint of the total adult German population utilizing public health insurance (70,107,122), of whom 1,019,079 were treated, was used. Both analyses focused on direct medical management costs (eg, hospital costs) related to clinical events and did not include other costs.What are the key takeaways?The study found that people with non-valvular atrial fibrillation who switched from apixaban to rivaroxaban had the potential to experience more stroke/systemic embolism and major bleeding events compared with those staying on apixaban. The increase in clinical events would likely result in an increase in clinical event-related healthcare costs in both the USA and Germany. The model showed that costs for people switching from apixaban to rivaroxaban could increase by $17 million ($366.97 per person treated or $17.26 per member) per year in the USA and by €153 million (€150.21 per person treated or €2.18 per member) per year in Germany.What were the main conclusions reported by the researchers?The study highlights the importance of considering both the medical impact and costs of clinical events when deciding whether to switch between treatments, as switching from apixaban to rivaroxaban was linked with an increased number of clinical events, deaths, and subsequent economic impact of costs on the healthcare system related to clinical events. Overall, continuing apixaban was associated with better results for people receiving treatment than switching to rivaroxaban along with reduced event-related costs.How to say (download PDF and double click sound icon to play sound)…Non-valvular atrial fibrillation: non-valv-u-lar a-tree-ul fib-ri-lationApixaban: a-pix-a-banRivaroxaban: riv-a-rox-a-banSystemic embolism: cis-stem-ik em-bo-lis-mmWhat it means …Stroke is a medical event where blood flow to the brain is reduced or blocked; it is classed as a medical emergencySystemic embolisms are similar to strokes but occur outside of the brain and affect another body part (eg, a leg)Major bleeding is a serious type of bleed that usually needs medical attention to prevent long-lasting harm; it may be life-threateningNon-valvular atrial fibrillation is a heart disorder that results in an increased risk of forming blood clotsDirect oral anticoagulants are medicines taken by mouth that prevent harmful blood clots forming by specifically blocking components in the body that cause the formation of blood clotsClinical events are any medical event that a person experiences, which included stroke/systemic embolism and bleeding events in this studyReal-world analysis is an analysis using data from people in real life rather than data from a self-contained clinical trialDecision models are tools that help to predict the likely result of various choices. In this study, a model helped to estimate clinical event frequencies and related costs based on how people were treated (ie, continued on apixaban or switched from apixaban to rivaroxaban)This is an abstract of the Plain Language Summary of Publication article.View the full Plain Language Summary PDF of this article to read the full-textLink to original article here