Comparison of the Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke and Systemic Embolism in Atrial Fibrillation in a UK Setting

Zheng, Ying; Sorensen, Sonja; Gonschior, Ann-Katrin; Noack, Herbert; Heinrich-Nols, Jutta; Sunderland, Tom; Kansal, Anuraag R.

doi:10.1016/j.clinthera.2014.09.015

Cited by 35 publications

(26 citation statements)

References 33 publications

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“…One study compared apixaban with vitamin K antagonists (VKAs) [19]. Eight studies compared warfarin with apixaban, dabigatran, and rivaroxaban [12, 16, 22, 25, 29–32]. One study compared apixaban with dabigatran [15], and one study compared apixaban with rivaroxaban [13].…”

Section: Resultsmentioning

confidence: 99%

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

Pinyol¹,

Cepeda

Roldán

et al. 2016

Cardiol Ther

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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.

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Section: Resultsmentioning

confidence: 99%

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

Pinyol¹,

Cepeda

Roldán

et al. 2016

Cardiol Ther

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“…In Erope, dabigatran has been approved for the prevention of venous thromboembolism after orthopedic surgery, such as total hip or knee replacement, and the prevention of stroke and systemic arterial embolism in high-risk patients with non-valvular atrial fibrillation (1,2,11,12,18). …”

Section: Discussionmentioning

confidence: 99%

“…If bleeding is severe, treatments available at the hospital level include mechanical compression, surgical interventions, fluid replacement, hemodynamic support, intake of activated carbon and hemodialysis (2). …”

Section: Discussionmentioning

confidence: 99%

“…In patients with atrial fibrillation, 80% of heart attacks cause death or disability, and mortality per year reaches 50%. Vitamin K antagonists such as warfarin and acenocoumarol are very effective in preventing strokes in patients with atrial fibrillation, and have been for many years; thus being the only drugs available for long-term anticoagulant therapy (1,2). …”

Section: Introductionmentioning

confidence: 99%

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Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature

Corcuera

Ramírez-Martínez-Acitores²,

Lopez-Pintor³

et al. 2016

Med Oral

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BackgroundDabigatran is a newly commercialized drug that is replacing other anticoagulants in the prevention of venous thromboembolism, stroke and systemic arterial valve embolism. It acts directly on thrombin presenting in a dynamic and predictable way, which does not require monitoring these patients. Therefore, we consider the need to assess whether their use increases the risk of bleeding involved before any dental treatment.Material and MethodsWe performed a systematic review with a bibliographic search in PubMed/Medline along with the Cochrane Library. We excluded articles dealing with all anticoagulants other than dabigatran, and works about surgical treatments in anatomical locations other than the oral cavity.ResultsWe included a total of 13 papers of which 1 was a randomized clinical trial, 9 narrative literature reviews, 1 case series, 2 clinical cases and 1 expert opinion. Because we did not obtain any properly designed clinical trials, we were unable to conduct a meta-analysis.ConclusionsCurrently, there is no consensus on the procedure to be followed in patients taking dabigatran. However, all authors agree to treat each case individually in accordance to the risk of embolism, postoperative bleeding and renal function. Also, it is necessary to perform minimally invasive interventions, and take the appropriate local anti-hemolytic measures. Key words:Oral anticoagulants, dabigatran, risk of bleeding, oral surgery, dentistry.

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“…The haemorrhagic and thromboembolic risks of the inappropriate use of DOACs might result in 0.19–4.41 adverse drug events (ADEs) per 100 patient-years 2. The consequences of these haemorrhagic and thromboembolic events represent a high societal and economic burden.…”

Section: Introductionmentioning

confidence: 99%

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

et al. 2017

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BackgroundPotential inappropriate use of direct oral anticoagulants (DOACs) increases the risk of thromboembolic and haemorrhagic events.PurposeTo determine the net cost benefit of clinical pharmacy interventions on the prescription of DOACs.MethodWe constructed a decision tree model using a public payer perspective. The appropriateness of the prescription was assessed using the Medication Appropriateness Index. The theoretical risks were collected from the literature and the individual potential risks were calculated using the Nesbit risk assignment conducted by two independent clinical pharmacists. Different costs were included based on diagnosis-related group coding and data in the literature. A univariate sensitivity analysis was performed.ResultsThirty-six of 75 patients had an inappropriate prescription of DOACs. The saved difference between avoided costs (7954€) and annualised medication costs and pharmacist cost (4323€) was 3631€ for 75 patients.ConclusionsIn addition to the enhancement of the quality of the prescription, our results indicate that pharmacist interventions provide a positive net cost benefit.

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Comparison of the Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke and Systemic Embolism in Atrial Fibrillation in a UK Setting

Abstract: Dabigatran was found to be economically dominant over rivaroxaban and apixaban in the UK setting. These economic findings are based on relative clinical efficacy from an indirect treatment comparison and would benefit from any data of direct comparisons of the NOACs in the future.

Cited by 35 publications

References 33 publications

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

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

Dabigatran: A new oral anticoagulant. Guidelines to follow in oral surgery procedures. A systematic review of the literature

Partial economic evaluation of clinical pharmacy interventions on the prescription of direct oral anticoagulants in a teaching hospital

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