OBJECTIVES: Based on clinical trials the oral anticoagulants (OACs) apixaban, 
dabigatran, and rivaroxaban are efficacious for reducing stroke risk for 
non-valvular atrial fibrillation (NVAF) patients. Based on the clinical trials, 
this study evaluated the medical costs for clinical events among NVAF patients 
≥75 and <75 years of age treated with individual OACs vs warfarin.
METHODS: Rates for primary and secondary efficacy and safety outcomes (i.e., 
clinical events) among NVAF patients receiving warfarin or each of the OACs were 
determined for NVAF populations aged ≥75 years and <75 years of age from the OAC 
vs warfarin trials. One-year incremental costs among patients with clinical 
events were obtained from published literature and inflation adjusted to 2010 
costs. Medical costs, excluding medication costs, for clinical events associated 
with each OAC and warfarin were then estimated and compared.
RESULTS: Among NVAF patients aged ≥75, compared to warfarin, use of either 
apixaban or rivaroxaban was associated with a reduction in medical costs per 
patient year (apixaban = -$825, rivaroxaban =-$23), while dabigatran use was 
associated with increased medical costs of $180 per patient year. Among NVAF 
patients <75 years of age medical costs per patient year were estimated to be 
reduced -$254, -$367, and -$88, for apixaban, dabigatran, and rivaroxaban, 
respectively, in comparison to warfarin.
LIMITATIONS: This economic analysis was based on clinical trial data and, 
therefore, the direct application of the results to routine clinical practice 
will require further assessment.
CONCLUSIONS: Difference in medical costs between OAC and warfarin treated NVAF 
patients vary by age group and individual OACs. Although reductions in medical 
costs for NVAF patients aged ≥75 and <75 were observed for those using either 
apixaban or rivaroxaban vs warfarin, the reductions were greater per patient 
year for both the older and younger NVAF populations using apixaban.