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

What 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. Box: see textBox: see textBox: see textLink to original article here.