Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium

Kongnakorn, Thitima; Lanitis, Tereza; Annemans, Lievens; Thijs, Vincent; Marbaix, Sophie

doi:10.1007/s40261-014-0224-z

Cited by 15 publications

(6 citation statements)

References 31 publications

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“…1, included in the model were NVAF, ischaemic stroke and haemorrhagic strokes (mild, moderate, severe and fatal), intracranial haemorrhage (ICH) other than haemorrhagic strokes (referred to as other ICH), systemic embolism, myocardial infarction (MI), other major bleeds (non-ICH major bleeds), clinically relevant non-major bleeding and NVAF with subsequent aspirin treatment or death. Details surrounding the model transitions, methodology around obtaining clinical inputs and assumptions have been previously described in detail [15,23,29], however, they are summarised in Tables 1 and 2 for completion.…”

Section: Model Designmentioning

confidence: 99%

Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin

et al. 2014

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Section: Model Designmentioning

confidence: 99%

Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin

et al. 2014

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“…The same assumption was applied in other prior studies. [17][18][19] In addition, results from univariate sensitivity analysis, varying utility for each clinical event by its' 95% confidence intervals, demonstrated that the ICERs were altered by only less than 4%.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Apixaban for Stroke Prevention in Patients with Atrial Fibrillation in Algeria

Aoudia

Kongnakorn²,

Merinopoulou³

et al. 2017

JHEOR

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Background: Atrial fibrillation (AF) is a chronic sustained heart rhythm disorder associated with an increased risk of stroke. Apixaban, a new oral anticoagulant, was approved by the European Medicines Agency for prevention of stroke in patients with AF. The efficacy of apixaban has been investigated in randomised controlled trials. Objectives: The objective of this study was to estimate the economic implications of using apixaban compared to other anti-coagulations to reduce the risk of stroke in patients with AF from the perspective of the Algerian payer. Methods: A previously published Markov model was adapted to the Algerian setting. The model included patients for whom vitamin K antagonist (VKA) treatment is suitable and could initiate on acenocoumarol, rivaroxaban or apixaban, and those unsuitable for VKA treatment who could initiate on aspirin or apixaban. Over a lifetime time horizon, costs were estimated in Algerian dinars (DZD) and outcomes included life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results: In the VKA suitable population, apixaban was estimated to be a dominant treatment option over rivaroxaban, providing a higher number of QALYs at lower costs, while when compared with acenocoumarol, an ICER of 3 672 059 DZD per QALY gained was estimated. Amongst those unsuitable for VKA therapy, the ICER was 2 061 863 DZD per QALY gained. Conclusion: Apixaban was found to be a cost-effective choice for stroke prevention in patients with AF in Algeria compared to acenocoumarol and rivaroxaban in the VKA suitable population and compared to aspirin in the VKA unsuitable population.

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“…To fit the 3-month cycle length of the model, all included transition probabilities were scaled to 3 months, assuming a constant rate in accordance with the methods described by Briggs et al [29]. Rates were converted into probabilities under the assumption of a constant rate model [31,32]. Input parameters limited within the range of 0-1, as for probabilities, were assumed to be outcomes of betadistributed derivates [30], whereas gamma distributions were assumed for non-negative parameters as rates.…”

Section: Transition Probabilitiesmentioning

confidence: 99%

Cost Effectiveness of Patient Self-Managed Warfarin Compared with Direct Oral Anticoagulants in Atrial Fibrillation: An Economic Evaluation in a Danish Healthcare Sector Setting

Raunbak

Sørensen

Hansen

et al. 2022

PharmacoEconomics Open

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Background Patient self-managed anticoagulant treatment with warfarin (PSM) has been proposed as an alternative to direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF); however, direct evidence on the cost effectiveness of PSM compared with DOACs is lacking. We aimed to evaluate the cost effectiveness of PSM versus DOACs for NVAF patients in the Danish healthcare setting using a model-based cost-utility analysis. Methods A cost-utility analysis was performed using a decision-analytic model including two treatment alternatives: continuous PSM and DOACs. The analysis was performed from an extended Danish healthcare sector perspective, including patient-paid costs of medication related to the anticoagulant treatment, with a lifetime horizon. Inputs for the model comprised of probabilities of events, costs in Danish estimates, when possible, and effect in utilities. The probabilities of events are primarily based on real-life data from a direct comparison of PSM and DOACs. The results are presented as the incremental cost-effectiveness ratio (ICER) with an assumed cost-effectiveness threshold of £20,000/quality-adjusted life-year (QALY). Both deterministic and probabilistic sensitivity analyses were performed to investigate the robustness of the results. ResultsThe base-analysis showed that PSM was dominant, with a decreased cost of £8495 and an increased QALY accumulation of 0.23 per patient (ICER = −£36,935/QALY). All deterministic sensitivity analyses indicated that PSM was dominant or at least cost effective. The probabilistic sensitivity analysis showed that 95% of the iterations were cost effective. Conclusions The present study found that PSM is dominant (i.e., both more effective and cost saving) compared with DOACs, adding to the scarce evidence of the comparative cost effectiveness of PSM and DOACs in NVAF.

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Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium

Abstract: Apixaban is a cost-effective alternative to aspirin for patients with AF in Belgium who decline or cannot tolerate VKA treatment.

Cited by 15 publications

References 31 publications

Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin

Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin

Cost-effectiveness of Apixaban for Stroke Prevention in Patients with Atrial Fibrillation in Algeria

Cost Effectiveness of Patient Self-Managed Warfarin Compared with Direct Oral Anticoagulants in Atrial Fibrillation: An Economic Evaluation in a Danish Healthcare Sector Setting

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