Arrhythmias & electrophysiologyRandomised controlled trial
Cost-effectiveness of apixaban vs. aspirin for the reduction of thrombo-embolism in high-risk patients with device-detected atrial fibrillation: insights from the ARTESiA trial
- Cost-effectiveness analysis of the ARTESiA randomised trial
- Markov model (lifetime)
- willingness-to-pay 50 000 US dollars (USD) per quality-adjusted life year (QALY)
Daily apixaban cost $0.63 (Canada), $0.11 (UK), $2.26 (Germany), $6.06 (US)
Authors' conclusion
In patients with SCAF and a CHA2DS2-VASc score > 4, apixaban is cost saving in Canada and the UK and cost-effective in Germany. Apixaban was not cost-effective in the USA under the base cost assumption but would be cost-effective at a daily cost of $4.35 and cost saving at $3.59.
Study context
- Population
- Participants with device-detected subclinical AF (subclinical atrial fibrillation (SCAF)) and CHA2DS2-VASc score > 4; Canadian, UK, German and US healthcare costs
- Comparison
- Apixaban vs aspirin
- Primary endpoint
- Mean cost per participant (in-trial) and incremental cost-effectiveness ratio over a lifetime
- Follow-up
- Mean 3.5 years; lifetime
Primary result
As reported in the abstract
In-trial cost difference, apixaban vs aspirin · mean 3.5 years
Canada: apixaban dominant (cost-saving and more effective)
-$2301
UK: apixaban dominant (cost-saving and more effective)
-$902
Germany: apixaban cost more
$600
US: apixaban cost more
$1990
Further findings
Lifetime cost-effectiveness
- Net gain with apixaban (QALYs)
- 0.107
- Germany: additional cost
- $2623
- US: additional cost
- $9110
- Germany: ICER per QALY
- $24 514
- US: ICER per QALY
- $85 140
Original publication
Cost-effectiveness of apixaban vs. aspirin for the reduction of thrombo-embolism in high-risk patients with device-detected atrial fibrillation: insights from the ARTESiA trial. Europace. Published 31 August 2025. doi:10.1093/europace/euaf195
Summarised from the published abstract; every number is checked against it