Clinical And Economic Analysis Of Effectiveness Of Fondaparinux Sodium In The Treatment Of Acute Coronary Syndrome

Abstract

A393lation (AF). It is therefore relevant to evaluate NOACs relative cost-effectiveness in Portuguese AF patients. Methods: A Markov model was used to analyze the disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeds and clinically relevant non-major bleeds), myocardial infarction and treatment discontinuation were used by means of pairwise indirect treatment comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Resource use was obtained from Diagnosis Related Group legislation data base and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results: Apixaban provided the highest life years gained and QALYs. The apixaban ICER versus warfarin and dabigatran was 5,529€ /QALY and 9,163€ /QALY, respectively. Apixaban was dominant versus rivaroxaban (higher health gains and lower costs). Results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% chance of being cost-effective (at a threshold of 20,000€ / QALY) versus the set of all other therapeutic options. ConClusions: Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant versus rivaroxaban in AF patients from a Portuguese national healthcare system perspective. These conclusions are based on indirect treatment comparisons. Despite this limitation, this information is relevant for different health care decision makers.