AIMS: Apixaban was superior to aspirin for the prevention of stroke or systemic embolism in participants with subclinical atrial fibrillation (SCAF) in the Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation trial. This was especially true for those with CHA2DS2-VASc score > 4. Understanding the cost-effectiveness of treating SCAF is important for decision-makers. METHODS AND RESULTS: Canadian, UK, German, and US direct healthcare costs [in 2023 US dollars (USD)] were applied to hospitalized events (including strokes and bleeds) and study drugs for all participants with a CHA2DS2-VASc score > 4 to determine the mean cost per participant during the trial (mean follow-up 3.5 years). A daily cost of $0.63, $0.11, $2.26, and $6.06 for apixaban in Canada, the UK, Germany, and the USA was used. If in-trial results were not cost-saving (below $0), the prospective plan was to perform a lifetime cost-effectiveness analysis using a Markov model and a willingness-to-pay of 50 000 USD per quality-adjusted life year (QALY). After considering the cost of study medication and clinical events over 3.5 years, apixaban was dominant (cost-saving and more effective) in Canada (-$2301) and the UK (-$902) but cost more in Germany and the USA ($600 and $1990, respectively). Over a lifetime, treatment with apixaban produced a net gain of 0.107 QALYs, but with costs in both Germany ($2623 more) and the USA ($9110 more), yielding an incremental cost-effectiveness ratio of $24 514 per QALY for Germany and $85 140 for the USA. 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.

• Klíčová slova
• Apixaban, Cost-effectiveness, Stroke prevention, Subclinical atrial fibrillation,
• MeSH
• analýza nákladů a výnosů MeSH
• Aspirin * ekonomika   terapeutické užití   škodlivé účinky   MeSH
• časové faktory MeSH
• cévní mozková příhoda prevence a kontrola   ekonomika   etiologie   MeSH
• ekonomické modely MeSH
• fibrilace síní * ekonomika   diagnóza   komplikace   farmakoterapie   MeSH
• fibrinolytika ekonomika   terapeutické užití   škodlivé účinky   MeSH
• inhibitory agregace trombocytů * ekonomika   terapeutické užití   škodlivé účinky   MeSH
• inhibitory faktoru Xa ekonomika   terapeutické užití   škodlivé účinky   MeSH
• kvalitativně upravené roky života MeSH
• lidé MeSH
• náklady na léky * MeSH
• pyrazoly * ekonomika   terapeutické užití   škodlivé účinky   MeSH
• pyridony * ekonomika   terapeutické užití   škodlivé účinky   MeSH
• rizikové faktory MeSH
• senioři MeSH
• tromboembolie * prevence a kontrola   ekonomika   etiologie   diagnóza   MeSH
• úspory nákladů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Kanada MeSH
• Spojené státy americké MeSH
• Názvy látek
• apixaban MeSH Prohlížeč
• Aspirin * MeSH
• fibrinolytika MeSH
• inhibitory agregace trombocytů * MeSH
• inhibitory faktoru Xa MeSH
• pyrazoly * MeSH
• pyridony * MeSH