The Relative Cost-Effectiveness of Anticoagulants

Avorn, Jerry

doi:10.1161/circulationaha.111.030148

Cited by 32 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, determining the economic impact of the shifting anticoagulant use at both a societal level and an individual level merits further investigation. 38 …”

Section: Discussionmentioning

confidence: 99%

National Trends in Ambulatory Oral Anticoagulant Use

Barnes

Lucas

Alexander

et al. 2015

The American Journal of Medicine

526

360

View full text Add to dashboard Cite

Background Four direct oral anticoagulants (DOACs) have been brought to market for the treatment of nonvalvular atrial fibrillation and venous thromboembolism. Many forces, including numerous positive trial results, emerging safety concerns, marketing and promotion may shape DOAC adoption by providers. However, relatively little is known regarding their ambulatory utilization compared with warfarin, as well as the degree to which they have decreased undertreatment of atrial fibrillation. Method We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of outpatient office visits, to estimate the use of warfarin and DOACs between 2009 and 2014. Results Overall, visits with anticoagulation use increased from 2.05 (95% CI 1.82-2.27) to 2.83 (95% CI 2.49-3.17) million (M) quarterly visits (p<0.001). Of these, DOAC use has grown to 4.21M (95% CI 3.63M-4.79M; 38.2% of total) treatment visits in 2014 since their introduction in 2010. Use of all oral anticoagulants in treatment visits for atrial fibrillation has increased from 0.88M (95% CI 0.74M-1.02M) to 1.72M (95% CI 1.47M -1.97M; p<0.001), with similar DOAC and warfarin use in 2014. Atrial Fibrillation visits with anticoagulant use increased from 51.9% (95% CI 50.4%-53.8%) to 66.9% (95% CI 65.0%-69.3%) between 2009 and 2014 (p<0.001). In 2014, rivaroxaban was the most commonly prescribed DOAC for atrial fibrillation (47.9% of office visits), followed by apixaban (26.5%) and dabigatran (25.5%). Conclusions DOACs have been rapidly adopted, matching the use of warfarin, and are associated with increased use of oral anticoagulation for patients with atrial fibrillation.

show abstract

“…Additionally, determining the economic impact of the shifting anticoagulant use at both a societal level and an individual level merits further investigation. 38 …”

Section: Discussionmentioning

confidence: 99%

National Trends in Ambulatory Oral Anticoagulant Use

Barnes

Lucas

Alexander

et al. 2015

The American Journal of Medicine

526

360

View full text Add to dashboard Cite

show abstract

“…3 Recent analysis indicates that warfarin is a cost-effective therapy when anticoagulation stability is well controlled. 4 Furthermore, good anticoagulation control with warfarin is also associated with increased safety.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

Kleinow¹,

Garwood²,

Clemente³

et al. 2011

JMCP

View full text Add to dashboard Cite

“…12 Previous economic analyses suggested that dabigatran seemed to represent relatively good value for money 13,14 but contained inaccuracies in the assessment of drug costs. 15 The trade-offs in quality and cost for rivaroxaban and apixaban compared with warfarin remain unknown. We, therefore, evaluated the comparative costeffectiveness of all the available oral agents for stroke prophylaxis in warfarin-eligible patients with AF.…”

mentioning

confidence: 99%

Cost-Effectiveness of Oral Anticoagulants for Treatment of Atrial Fibrillation

Canestaro

Patrick

Avorn

et al. 2013

Circ: Cardiovascular Quality and Outcomes

Self Cite

View full text Add to dashboard Cite

Background-New anticoagulants may improve health outcomes in patients with atrial fibrillation, but it is unclear whether their use is cost-effective. Methods and Results-A Markov state transition was created to compare 4 therapies: dabigatran 150 mg BID, apixaban 5 mg BID, rivaroxaban 20 mg QD, and warfarin therapy. The population included those with newly diagnosed atrial fibrillation who were eligible for treatment with warfarin. Compared with warfarin, apixaban, rivaroxaban, and dabigatran, costs were $93 063, $111 465, and $140 557 per additional quality-adjusted life year gained, respectively. At a threshold of $100 000 per quality-adjusted life year, apixaban provided the greatest absolute benefit while still being cost-effective, although warfarin would be superior if apixaban was 2% less effective than expected. Although apixaban was the optimal strategy in our base case, in probabilistic sensitivity analysis, warfarin was optimal in an equal number of iterations at a cost-effectiveness threshold of $100 000 per quality-adjusted life year. Conclusions-While at a standard cost-effectiveness threshold of $100 000 per quality-adjusted life year, apixaban seems to be the optimal anticoagulation strategy; this finding is sensitive to assumptions about its efficacy and cost. In sensitivity analysis, warfarin seems to be the optimal choice in an equal number of simulations. As a result, although all the novel oral anticoagulants produce greater quality-adjusted life expectancy than warfarin, they may not represent good value for money.

show abstract

The Relative Cost-Effectiveness of Anticoagulants

Cited by 32 publications

References 18 publications

National Trends in Ambulatory Oral Anticoagulant Use

National Trends in Ambulatory Oral Anticoagulant Use

Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

Cost-Effectiveness of Oral Anticoagulants for Treatment of Atrial Fibrillation

Contact Info

Product

Resources

About