{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T05:54:52Z","timestamp":1762322092671,"version":"3.41.2"},"reference-count":63,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study evaluates the cost\u2010effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non\u2010valvular atrial fibrillation in Iran.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A Markov model with a 30\u2010year time horizon was employed to simulate and assess different treatment strategies' cost\u2010effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality\u2010adjusted life years (QALY) were assessed using an EQ\u20105D questionnaire. This study utilized a cost\u2010effectiveness threshold of $11\u2009134 per QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Apixaban demonstrated superior cost\u2010effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost\u2010effectiveness ratio for comparing Apixaban to Warfarin was calculated at \u22121332.83 cost per QALY, below the threshold of $11\u2009134, indicating Apixaban's cost\u2010effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024\u22122028) of Apixaban usage, the incremental cost starts at USD 70\u2009250\u2009296 in the first year and gradually rises to USD 71\u2009770\u2009662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study shows that Apixaban is a cost\u2010effective option for stroke prevention in non\u2010valvular atrial fibrillation patients in Iran compared to Warfarin.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24311","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T13:12:43Z","timestamp":1719234763000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost\u2010Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non\u2010Valvular Atrial Fibrillation (NVAF) in Iran"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3767-9921","authenticated-orcid":false,"given":"Amirmohammad","family":"Tajik","sequence":"first","affiliation":[{"name":"School of Pharmacy Mashhad University of Medical Sciences Mashhad Iran"},{"name":"Health Policy Research Center, Institute of Health Shiraz University of Medical Sciences Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azam","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Department of Management Sciences and Health Economics, School of Health Mashhad University of Medical Sciences Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Goudarzi","sequence":"additional","affiliation":[{"name":"School of Health Management and Information Sciences,\u00a0Health Human Resources Research Center Shiraz University of Medical Sciences Shiraz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azadeh","family":"Izadi\u2010Moud","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Varmaghani","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center Mashhad University of Medical Sciences Mashhad Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"issue":"7","key":"e_1_2_11_2_1","first-page":"257","article-title":"ACC\/AHA\/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society","volume":"114","author":"Fuster V.","year":"2006","journal-title":"Circulation"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00031.2009"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2004.03656.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.48.3.193"},{"issue":"14","key":"e_1_2_11_6_1","first-page":"e506","article-title":"2015 ACC\/AHA\/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"133","author":"Page R. 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