Alternative anticoagulants to warfarin (dabigatran, rivaroxaban, and apixaban) 
are becoming available for the prevention of thromboembolic stroke in atrial 
fibrillation (AF), but there is a lack of information on their comparative 
effectiveness. Using a discrete event simulation method adopting a lifetime 
horizon of analysis, we made an indirect comparison of the RE-LY, ROCKET-AF, and 
ARISTOTLE trial results for AF patients in the US population. Over a lifetime, 
apixaban, dabigatran, and rivaroxaban accrued 0.130 (95% central range (CR) 
-0.030 to 0.264), 0.106 (95% CR -0.048 to 0.248), and 0.095 (95% CR -0.052 to 
0.242) more quality-adjusted life-years (QALYs), respectively, than warfarin, 
with apixaban having a 55% probability of accruing the highest total QALYs. In 
the absence of a definitive trial, and acknowledging the limitations of an 
indirect comparison, the available evidence suggests apixaban to be the most 
effective anticoagulant.