A Systematic Literature Review on the Cost-Effectiveness of Apixaban for Stroke Prevention in Non-valvular Atrial Fibrillation

Abstract

IntroductionEconomic evaluations are becoming increasingly important due to limitations in economic resources, the expense of many new treatments, the need to allocate health spending as effectively as possible, and the need to inform decision makers. Based on the data from the apixaban studies (ARISTOTLE and AVERROES), several economic evaluations have been performed in various countries to demonstrate the efficacy of apixaban versus warfarin and aspirin or other new oral anticoagulants (NOACs) for preventing stroke in patients with non-valvular atrial fibrillation (NVAF).The aim of this study was to perform a systematic literature review of published economic evaluations with apixaban in the indication of stroke prevention in patients with NVAF.MethodsA search in PubMed, Cochrane Library, Google Scholar, and Index Medicus Español was conducted in June 2015. Inclusion and exclusion criteria were established. The main characteristics were recorded for all relevant articles after being reviewed. In addition, a weighted version of the Drummond’s checklist was used to further assess the quality of the selected studies.ResultsAfter review, 26 cost-effectiveness analyses through Markov models were included; the identified economic evaluations represent different willingness-to-pay (WTP) thresholds, discount rates, medical costs, and healthcare systems. Apixaban was compared with warfarin/acenocoumarol in 7 of them (27%), with warfarin/NOACs in 14 (54%), with aspirin in 2 (8%), and with warfarin/aspirin in 3 (11%). Models were conducted from Europe (69%), USA (23%), Australia (4%), and Latin America (4%). All models reported cost/quality-adjusted life years (QALYs) gained, 92% reported using a payer perspective, and 8% using a societal perspective; the median quality score of the selected studies was 89 (out of 119), with a range of 55–103. In models performed in Europe, incremental cost-effectiveness ratios (ICERs) of apixaban versus warfarin ranged from €5607/QALY to €57,245/QALY, while ICERs versus aspirin ranged from being dominant to €7334/QALY. In models carried out in the USA, ICERs of apixaban versus warfarin ranged from being dominant to $93,063/QALY.ConclusionDifferent cost-effectiveness analyses suggest that apixaban is a cost-effective therapeutic option according to the WTP thresholds used in countries where cost-effectiveness analyses, were performed.FundingBMS and Pfizer.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-016-0066-2) contains supplementary material, which is available to authorized users.

Patient satisfaction after conversion from warfarin to direct oral anticoagulants for patients on extended duration of anticoagulation for venous thromboembolism – The SWAN Study

“…Furthermore, despite the discrepancy in patient cost because of the requirement for monthly repeat prescriptions, recent studies have suggested that DOAC therapy and in particular apixaban are in general cost-effective to the health system when compared to warfarin for stroke prevention in patients with non-valvular AF. [19][20][21] After switching from warfarin to DOACs, clinically relevant non-major bleeding was the most common side effect that necessitated further management. This finding is consistent with the reports of menorrhagia in woman of childbearing age prescribed DOACs but with appropriate intervention, the DOAC can generally be continued for effective thrombosis risk PLOS ONE reduction.…”

Cost-Effectiveness Analysis of Apixaban Versus Edoxaban in Patients with Atrial Fibrillation for Stroke Prevention

“…The efficiency of these drugs has been assessed in different settings and with different comparators. These studies include cost-effectiveness analyses of apixaban versus warfarin, acenocoumarol, ASA, dabigatran and rivaroxaban [ 13 ] and, most recently, a cost-utility analysis versus edoxaban in the UK [ 14 ]. Evaluations specifically for the Spanish setting include those for apixaban versus acenocoumarol [ 15 ], apixaban versus dabigatran [ 16 ] and apixaban versus rivaroxaban [ 17 ].…”

Estimating the cost-effectiveness of treatment for prevention of thromboembolic events in at-risk adults with non-valvular atrial fibrillation

“…The economic value of apixaban has been demonstrated in an independent cost-effectiveness analysis conducted in UK and based on the data from a network meta-analysis of 23 RCTs [12], which showed that apixaban has a slightly higher expected quality-adjusted life expectancy (QALYs: 5.49 vs. 5.45 of rivaroxaban, 5.42 of dabigatran 150 mg, and 5.41 of edoxaban 60 mg) and the highest probability of being the most cost-effective first-line therapy for AF (close to 60% for willingness to pay thresholds of £ 20,000-30,000). In a systematic review on the cost-effectiveness of apixaban for stroke prevention, which included 23 costeffectiveness studies from 14 countries, apixaban appears to be more cost-effective than warfarin and other DOACs [27].…”