4D-01 - Cost-Effectiveness Analysis of Novel Oral Anticoagulant and Vitamin K Antagonist for the Anticoagulant Treatment of Chinese Patients with Postoperative Atrial Fibrillation: A Comparative Study Using Real-World Data

Background: Novel oral anticoagulants (NOAC) and vitamin K antagonist (VKA) are common oral anticoagulants for patients with postoperative atrial fibrillation (POAF) in China. To our knowledge, this is the first economic evaluation to assess the value of oral anticoagulants based on the clinical characteristics and the usage situations of oral anticoagulants in Asian patients with POAF.

Objectives: To assess the cost-effectiveness of NOAC and VKA using data from real practice based on the perspective of the healthcare system in China.

Methods: We collected the baseline characteristics and cost-related information of POAF patients from the Jiangsu Province Big Data Platform from August 2015 to June 2022, including patients with new-onset AF who underwent coronary artery bypass grafting (CABG), valve surgery, or percutaneous coronary intervention (PCI). Propensity score matching (PSM) was employed according to a 1:1 ratio. Based on Chinese real-world data, published literature, and third-party data, this study built a Markov model to assess the cost-effectiveness of NOAC and VKA.

Results: After PSM, a total of 1,022 patients were included, with 511 in NOAC group and 511 in VKA group. The mean patient follow-up period was 29 days. Markov models based on real-world and third-party data showed that NOAC performed well compared with VKA, with an incremental cost-effectiveness ratio (ICER) below one time the Gross Domestic Product (GDP) per capita of China in 2023. In deterministic sensitivity analysis, we found that the cost of NOAC during POAF stability, subsequent treatment costs after thromboembolism, and subsequent treatment costs after bleeding had the most significant impact on model outcomes. Probabilistic sensitivity analysis indicated that NOAC and VKA had comparable cost-effectiveness at a willingness-to-pay (WTP) threshold of 49,000 yuan per quality-adjusted life year (QALY), with NOAC becoming more cost-effective as WTP increases.

Conclusions: Economic analyses show that NOAC is more cost-effective relative to VKA, particularly at higher WTP thresholds of 49,000 yuan per QALY.