Cost-effectiveness analysis of apixaban compared to other direct oral anticoagulants for prevention of stroke in Austrian atrial fibrillation patients.

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Abstrakt

Tytuł:: Cost-effectiveness analysis of apixaban compared to other direct oral anticoagulants for prevention of stroke in Austrian atrial fibrillation patients.
Autorzy:: Walter E; IPF Institute for Pharmaeconomic Research, Vienna, Austria.
Voit M; IPF Institute for Pharmaeconomic Research, Vienna, Austria.
Eichhober G; IPF Institute for Pharmaeconomic Research, Vienna, Austria.
Źródło:: Expert review of pharmacoeconomics & outcomes research [Expert Rev Pharmacoecon Outcomes Res] 2021 Apr; Vol. 21 (2), pp. 265-275. Date of Electronic Publication: 2020 Aug 23.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Publication: 2015- : Abingdon, Oxford : Taylor & Francis
Original Publication: London : Future Drugs Ltd, [2001-
MeSH Terms:: Atrial Fibrillation/*drug therapy
Factor Xa Inhibitors/*administration & dosage
Pyrazoles/*administration & dosage
Pyridones/*administration & dosage
Stroke/*prevention & control
Aged ; Aged, 80 and over ; Anticoagulants/administration & dosage ; Anticoagulants/economics ; Atrial Fibrillation/complications ; Atrial Fibrillation/economics ; Austria ; Cost-Benefit Analysis ; Factor Xa Inhibitors/economics ; Female ; Humans ; Male ; Middle Aged ; Models, Econometric ; Pyrazoles/economics ; Pyridones/economics ; Quality-Adjusted Life Years ; Randomized Controlled Trials as Topic ; Stroke/economics ; Stroke/etiology ; Warfarin/administration & dosage ; Warfarin/economics
Contributed Indexing:: Keywords: Cost-effectiveness; apixaban; atrial fibrillation; cost-utility; stroke prevention
Substance Nomenclature:: 0 (Anticoagulants)
0 (Factor Xa Inhibitors)
0 (Pyrazoles)
0 (Pyridones)
3Z9Y7UWC1J (apixaban)
5Q7ZVV76EI (Warfarin)
Entry Date(s):: Date Created: 20200724 Date Completed: 20210428 Latest Revision: 20220421
Update Code:: 20240104
DOI:: 10.1080/14737167.2020.1798233
PMID:: 32700584
: Czasopismo naukowe

Objectives: Several direct oral anticoagulants (DOACs) have been approved by the European Medicines Agency since 2008. The aim of the present cost-effectiveness-analysis was to analyze apixaban compared to other DOACs and vitamin K antagonists (warfarin) in Austria.
Methods: A cost-utility-model was developed to simulate lifetime-costs and quality-adjusted-life-years of DOACs and warfarin, based on a published Markov-Model and 23 randomized trials with 94,656 atrial-fibrillation (AF) patients. Each year, a patient has a probability of suffering a clinically relevant (extracranial) bleed, an intracranial hemorrhage (ICH), an ischemic stroke or a myocardial infarction (MI), remaining healthy, or deceasing. Direct-costs (2018€) were derived from published sources from the payer's perspective.
Results: In the base-case, warfarin had the lowest cost of 12,968 € (95%-CI±593 €) followed by apixaban (15,269 €±661 €), edoxaban (15,534 €±641 €), dabigatran (15,687 €±667 €), and rivaroxaban (17,522 €±764 €). Apixaban had the highest quality-adjusted-life-years estimate at 5.45 (SD, 0.06). In a Monte-Carlo probabilistic sensitivity analysis, apixaban was cost-effective vs. edoxaban, dabigatran, warfarin, and rivaroxaban in 85.6%, 79.0%, 76.4%, and 61.2% of the simulations, respectively.
Conclusion: In patients with AF and an increased risk of stroke, prophylaxis with apixaban was highly cost-effective from the perspective of the Austrian health-care system.

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