Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina

Giorgi, Mariano; Caroli, Christian; Giglio, Norberto; Micone, Paula; Aiello, Eleonora; Vulcano, Cristina; Blanco, Julia; Donato, B.M.K.; Quevedo, Joaquin Mould

doi:10.1186/s13561-015-0052-8

Cited by 17 publications

(14 citation statements)

References 31 publications

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“…Indeed, the use of NOACs in AF patients would eliminate the requirement for frequent monitoring, which may limit the use of AC therapy in many regions of Latin America. Challenges in improving the prescribing of this new class of drugs include: patient education and lack of adequate public health policies related to the cost of NOACs, which may be unaffordable for many regions in Latin America, although several pharmaco‐economic studies have shown NOACs to be more cost‐effective than VKAs in Latin America . NOAC use is likely to increase in coming years, given their favorable safety and efficacy profile, as guidelines are updated .…”

Section: Discussionmentioning

confidence: 99%

Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Jerjes‐Sánchez

Corbalán

Barretto

et al. 2019

Clinical Cardiology

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Background Atrial fibrillation (AF) is an important preventable cause of stroke. Anticoagulation (AC) therapy can reduce this risk. However, prescribing patterns and outcomes in patients with non‐valvular AF (NVAF) from Latin American countries are poorly described. Methods Using data from the Global Anticoagulant Registry in the FIELD‐AF (GARFIELD‐AF), we examined the stroke prevention strategies and the 1‐year outcomes in patients from four Latin American countries: Argentina, Brazil, Chile, and Mexico. Results A total of 4162 patients (2010‐2014) were included in this analysis. At the time of AF diagnosis, 39.9% of patients were prescribed vitamin K antagonists (VKA) ± antiplatelet (AP) therapy, 21.8% non‐VKA oral anticoagulant (NOAC) ± AP, 24.1% AP only and 14.1% no antithrombotic treatment. The proportion of moderate‐high risk patients receiving no AC therapy at participating centers was highest in Mexico (46.4%) and lowest in Chile (14.3%). During 1‐year follow‐up, the rates of all‐cause mortality, stroke/SE and major bleeding were: 5.77 (95% CI) (5.06‐6.56), 1.58 (1.23‐2.02), and 0.99 (0.72‐1.36) and per 100 person‐years, respectively, which are higher than the global rates across all countries in GARFIELD‐AF. Unadjusted rates of all‐cause mortality were highest in Argentina, 6.95 (5.43‐8.90), and lowest in Chile, 4.01 (2.92‐5.52). Conclusions GARFIELD‐AF results describes the marked variation in the baseline characteristics and patterns of antithrombotic treatments in patients with NVAF in four Latin American countries. Over one‐third of patients with a moderate‐to‐high risk of stroke received no AC therapy, highlighting the need for improved management of patients according to national guideline. Clinical Trial Registration—URL http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

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Section: Discussionmentioning

confidence: 99%

Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Jerjes‐Sánchez

Corbalán

Barretto

et al. 2019

Clinical Cardiology

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“…Sixteen articles were included in this review, which were published between 2012 and 2020.Most of these studies were from Thailand (n=4) ( 28 - 31 ), Russia (n=3) ( 32 - 34 ), Colombia (n=3) ( 34 - 36 ), China (n=2) ( 37 , 38 ), Indonesia (n=1) ( 37 - 39 ), Argentina (n=1) ( 40 ), Korea (n=1) ( 41 ) and South Africa (n=1) ( 42 ). Most of the studies (n=8) were conducted from the payer prospective ( 30 , 32 , 34 - 36 , 39 , 40 , 42 ). Five studies were designed in a health system perspective ( 28 , 31 , 33 , 37 , 38 ), while five studies had a societal perspective ( 28 - 31 , 41 ).…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation in Low and Middle-Income Countries: A Systematic Review

Souresrafil

Abutorabi

Peighambari

et al. 2022

Med. J. Islam. Republ. Iran

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Background: Low- and middle-income (LMICs) countries are facing with a high incidence of cardiovascular diseases and limited resources for confronting these diseases. Atrial fibrillation(AF) is the most common cardiac arrhythmia in the world that is associated with significant morbidity and mortality. This study assessed cost-effectiveness studies of novel oral anticoagulants(NOACs) compared to Warfarin for the prevention of stroke in patients with AF in LMICs. Methods: In this systematic review study, electronic databases were searched for economic evaluation studies about NOACs cost-effectiveness conducted in LMICs between 2008 and 2019. The selection of studies for review was also based on the PICO (population, intervention, comparison, and outcomes) guidelines. In this study, the population was restricted to patients with atrial fibrillation living in LMICs. We identified three types of drugs (apixaban, rivaroxaban, dabigatran, and edoxaban) as interventions and warfarin as the comparison therapy. Quality of Health Economic Studies checklist was used to evaluate the quality of the included articles. Results: Sixteen articles were extracted, including four cost-effectiveness analyses and two cost-utility analyses. QHES scores ranged from 58 to 87.5 out of a possible 100 points, with a mean score of 77.34. The results of the study showed that from a social perspective, Edoxaban is the most cost-effective therapeutic option compared to warfarin and other NOACs, but Warfarin was much more cost-effective than Rivaroxaban and Apixaban. Furthermore, NOACs were more cost-effective than warfarin from the payer perspective, but from the health system perspective, all NOACs were dominated by warfarin. Conclusion: The present systematic review demonstrates that from a social perspective, Edoxaban is the optimal alternative to warfarin other NOACs for stroke prevention in patients with AF in (LMICs). one study was found on the economic evaluation of NOACs and warfarin in patients with AF in low-income countries, so further research on the economic evaluation of these drugs is recommended.

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“…Ten of the reviewed articles were adaptations of these models to different countries [10, 12–15, 18–21, 27]. …”

Section: Resultsmentioning

confidence: 99%

“…Five studies compared apixaban with the standard therapy of warfarin or acenocoumarol [10, 14, 28, 33, 34]. Two studies compared apixaban with aspirin [18, 35].…”

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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Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina

Cited by 17 publications

References 31 publications

Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Stroke prevention in patients from Latin American countries with non‐valvular atrial fibrillation: Insights from the GARFIELD‐AF registry

Cost-effectiveness of New Oral Anticoagulants for the Prevention of Stroke in Patients with Atrial Fibrillation in Low and Middle-Income Countries: A Systematic Review

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

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