Safety, effectiveness, and cost-effectiveness of new oral anticoagulants compared with Warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation : Therapeutic review : Safety, effectiveness, and cost-effectiveness of new oral anticoagulants compared with Warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation

Finally, the results of the MTC were used to evaluate the cost-effectiveness of warfarin and the NOACs following standard procedures.8 The price of apixaban was assumed because this drug was not approved at the time that this report was prepared. [...] In addition to the limitations imposed by the clinical data, the results of the analysis of cost-effectiveness of the NOACs and warfarin were limited by the uncertainty regarding the pricing of the NOACs. [...] However, the results of the cost-effectiveness analysis were highly sensitive to the patient population under consideration, reinforcing the need for tailoring the treatment of individual patients according to individual characteristics that affect treatment outcomes(includes the degree of control of which warfarin therapy (TTR), age, risk of stroke, and history of thromboembolic events). [...] The management of patients with AF begins with the recognition of the risk and the prevention of thromboembolic complications. [...] The risk of bleeding is likely to be higher in common clinical practice than in the rigorous setting of a clinical trial with a dedicated anticoagulation service.32 Fear of adverse events and the complexity of dose management are key factors contributing to the widespread underuse of warfarin for patients with AF who are qualified candidates for therapy.