From the Guidelines
Warfarin is the most cost-effective alternative to Eliquis (apixaban), typically costing $4-10 per month compared to Eliquis's $500+ monthly price. Warfarin requires regular blood monitoring (INR tests) to ensure proper dosing and has more food and drug interactions, but it's been used safely for decades 1. According to the ARISTOTLE trial, apixaban was superior to warfarin in preventing stroke and systemic embolism and produced less bleeding, with an annual rate of primary efficacy outcome of 1.27% per year in the apixaban group and 1.60% per year in the warfarin group (HR, 0.79; 95% CI, 0.66-0.95; P < 0.001 for noninferiority and < 0.01 for superiority) 1. However, considering the cost and the fact that other direct oral anticoagulants (DOACs) like Xarelto (rivaroxaban) and Pradaxa (dabigatran) are similarly priced to Eliquis, offering few cost savings, warfarin remains a viable option 1.
Some key points to consider when choosing an anticoagulant include:
- The patient's specific medical condition, kidney function, and other individual factors
- The need for regular blood monitoring (INR tests) with warfarin
- The potential for food and drug interactions with warfarin
- The cost of the medication, with warfarin being significantly cheaper than Eliquis and other DOACs
- The availability of generic versions of Eliquis, which are expected in 2026 and should significantly reduce costs
- The potential for manufacturer discount programs or Medicare Part D plans to reduce costs for patients with commercial insurance or Medicare, respectively.
It's essential to consult with a healthcare provider before switching medications to determine the best course of treatment for each individual patient.
From the Research
Cheap Alternatives to Apixaban (Eliquis)
- Warfarin is a cheap and effective alternative to Apixaban, although it requires regular blood monitoring and dose adjustment 2
- Other non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, and edoxaban may be considered as alternatives to Apixaban 3
- Studies have shown that Apixaban is cost-effective compared to warfarin, dabigatran, and rivaroxaban in patients with nonvalvular atrial fibrillation 4, 5, 6
- The cost-effectiveness of Apixaban compared to other anticoagulants may vary depending on the specific patient population, healthcare setting, and perspective 4, 5, 6
Key Findings
- Apixaban was found to be cost-effective compared to warfarin, dabigatran, and rivaroxaban in a US cost-effectiveness analysis 4
- A study in the Netherlands found that Apixaban was dominant (cost-saving and more effective) over dabigatran, edoxaban, and rivaroxaban in patients with atrial fibrillation 5
- A UK-based study found that Apixaban was a cost-effective alternative to dabigatran and rivaroxaban for stroke prevention in atrial fibrillation patients 6
Considerations
- The selection of an alternative to Apixaban should be based on individual patient characteristics, such as renal function, bleeding risk, and medication adherence 3
- The cost-effectiveness of Apixaban and other anticoagulants may be influenced by factors such as drug prices, healthcare setting, and patient population 4, 5, 6