The use of direct oral anticoagulants has continued to increase since the approval of the direct thrombin inhibitor, dabigatran, in 2010. Sensitivity analyses further indicated that while Andexxa may be cost-effective to treat gastrointestinal bleeds, medication trial data will likely need to show significant impact on a patient’s quality of life and relative risk of death following an intracranial bleed to be cost-effective.ĭiscussion: Although the application of these findings is restricted due to limited trial data, beginning to understand the cost-effectiveness of Andexxa provides policymakers important insight into the economic value of the intervention. Results: The Markov model showed that the incremental cost-effectiveness ratio of Andexxa over the standard of care is $211,056 for an intracranial hemorrhage and $40,718 for a gastrointestinal bleed. The model included a hypothetical cohort of patients aged 65 years at an increased risk of stroke due to nonvalvular atrial fibrillation and with no contraindication to anticoagulation. Multiple 1-way and 2-way sensitivity analyses were also constructed to delineate the impact Andexxa would need to have on mortality rates and health-related quality of life to meet the willingness-to-pay thresholds ranging between $50,000 and $150,000. Methods: To explore the cost-effectiveness of Andexxa, a Markov model was generated using existing Andexxa trial data and related literature. Andexxa is costly, however, ranging between US $24,750 and $49,500 for treatment. It has been reported to substantially reduce mortality rates for patients who experience a major bleed while taking rivaroxaban or apixaban. In May 2018, the US Food and Drug Administration approved andexanet alfa (Andexxa), the first known reversal agent for a subset of direct factor Xa inhibitors. Introduction: Tens of thousands of patients die of major life-threatening bleeds every year while taking direct factor Xa inhibitors, a class of anticoagulant medications that until now had no reversal agent.
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