INTRODUCTION AND OBJECTIVES: Cost-effectiveness analysis of apixaban (5 mg twice 
daily) vs acenocoumarol (5mg/day) in the prevention of stroke in patients with 
nonvalvular atrial fibrillation in Spain.
METHODS: Markov model covering the patient's entire lifespan with 10 health 
states. Data on the efficacy and safety of the drugs were provided by the 
ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic 
equivalence.
PERSPECTIVES: The Spanish National Health System and society. Information on the 
cost of the drugs, complications, and the management of the disease was obtained 
from Spanish sources.
RESULTS: In a cohort of 1000 patients with nonvalvular atrial fibrillation, 
administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 
hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic 
embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) 
and result in more quality-adjusted life years (by 0.194 years) per patient. 
With apixaban, the incremental costs for the Spanish National Health System and 
for society would be € 2,488 and € 1,826 per patient, respectively. 
Consequently, the costs per life year gained would be € 13,305 and € 9,765 and 
the costs per quality-adjusted life year gained would be € 12,825 and € 9,412 
for the Spanish National Health System and for society, respectively. The 
stability of the baseline case was confirmed by sensitivity analyses.
CONCLUSIONS: According to this analysis, apixaban may be cost-effective in the 
prevention of stroke in patients with nonvalvular atrial fibrillation compared 
with acenocoumarol.