Cost-Effectiveness of Apixaban versus Other Direct Oral Anticoagulants and Warfarin in the Prevention of Thromboembolic Complications Among Finnish Patients with Non-Valvular Atrial Fibrillation
© 2021 Hallinen et al..
PURPOSE: Direct oral anticoagulant (DOAC) use for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) has increased steadily in Finland. DOACs have been shown to be cost-effective in comparison to warfarin, but published evidence of relative cost-effectiveness between DOACs is still scarce and mostly based on indirect comparisons of clinical trial evidence. The aim of this study was to compare the cost-effectiveness of apixaban to dabigatran, rivaroxaban and warfarin in a Finnish setting using real-life evidence where available.
PATIENTS AND METHODS: A lifetime Markov simulation model used previously in a published Finnish assessment comparing apixaban and warfarin was modified and updated with the relative effectiveness and safety data available from the real-world NAXOS-study and representative Finnish input data for patient characteristics, event risks, mortality, resource use, costs, and quality of life. Apixaban's cost-effectiveness was assessed from health care payer perspective (using 3% per year discount rate) based on incremental cost-effectiveness ratio (ICER, cost per quality-adjusted life year [QALY] gained), probability of cost-effectiveness (at willingness-to-pay [WTP] of 35,000 euros/QALY), and net monetary benefit (NMB).
RESULTS: Apixaban increased the average modelled quality-adjusted life-expectancy and reduced the average total health care costs of AF patients when compared to warfarin (+0.14 QALYs, -3691 euros), dabigatran (+0.11 QALYs, -404 euros), and rivaroxaban (+0.03 QALYs, -43 euros). The resulting NMB of apixaban versus warfarin, dabigatran and rivaroxaban was 8723, 4168, and 1129 euros, respectively. The respective probabilities of apixaban being cost-effective against each comparator were 100%, 92.7%, and 64.0%.
CONCLUSION: In this modelling study, apixaban dominated other anticoagulants in the Finnish real-life setting.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
|---|---|
| Enthalten in: |
ClinicoEconomics and outcomes research : CEOR - 13(2021) vom: 01., Seite 745-755 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Hallinen, Taru [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Apixaban |
|---|
| Anmerkungen: |
Date Revised 25.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.2147/CEOR.S317078 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM32957096X |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM32957096X | ||
| 003 | DE-627 | ||
| 005 | 20231226203449.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.2147/CEOR.S317078 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1098.xml |
| 035 | |a (DE-627)NLM32957096X | ||
| 035 | |a (NLM)34413661 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Hallinen, Taru |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cost-Effectiveness of Apixaban versus Other Direct Oral Anticoagulants and Warfarin in the Prevention of Thromboembolic Complications Among Finnish Patients with Non-Valvular Atrial Fibrillation |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 25.04.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2021 Hallinen et al. | ||
| 520 | |a PURPOSE: Direct oral anticoagulant (DOAC) use for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) has increased steadily in Finland. DOACs have been shown to be cost-effective in comparison to warfarin, but published evidence of relative cost-effectiveness between DOACs is still scarce and mostly based on indirect comparisons of clinical trial evidence. The aim of this study was to compare the cost-effectiveness of apixaban to dabigatran, rivaroxaban and warfarin in a Finnish setting using real-life evidence where available | ||
| 520 | |a PATIENTS AND METHODS: A lifetime Markov simulation model used previously in a published Finnish assessment comparing apixaban and warfarin was modified and updated with the relative effectiveness and safety data available from the real-world NAXOS-study and representative Finnish input data for patient characteristics, event risks, mortality, resource use, costs, and quality of life. Apixaban's cost-effectiveness was assessed from health care payer perspective (using 3% per year discount rate) based on incremental cost-effectiveness ratio (ICER, cost per quality-adjusted life year [QALY] gained), probability of cost-effectiveness (at willingness-to-pay [WTP] of 35,000 euros/QALY), and net monetary benefit (NMB) | ||
| 520 | |a RESULTS: Apixaban increased the average modelled quality-adjusted life-expectancy and reduced the average total health care costs of AF patients when compared to warfarin (+0.14 QALYs, -3691 euros), dabigatran (+0.11 QALYs, -404 euros), and rivaroxaban (+0.03 QALYs, -43 euros). The resulting NMB of apixaban versus warfarin, dabigatran and rivaroxaban was 8723, 4168, and 1129 euros, respectively. The respective probabilities of apixaban being cost-effective against each comparator were 100%, 92.7%, and 64.0% | ||
| 520 | |a CONCLUSION: In this modelling study, apixaban dominated other anticoagulants in the Finnish real-life setting | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a apixaban | |
| 650 | 4 | |a cost-utility | |
| 650 | 4 | |a dabigatran | |
| 650 | 4 | |a economic evaluation | |
| 650 | 4 | |a rivaroxaban | |
| 650 | 4 | |a warfarin | |
| 700 | 1 | |a Soini, Erkki |e verfasserin |4 aut | |
| 700 | 1 | |a Asseburg, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Linna, Miika |e verfasserin |4 aut | |
| 700 | 1 | |a Eloranta, Pia |e verfasserin |4 aut | |
| 700 | 1 | |a Sintonen, Sari |e verfasserin |4 aut | |
| 700 | 1 | |a Kosunen, Mikko |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t ClinicoEconomics and outcomes research : CEOR |d 2012 |g 13(2021) vom: 01., Seite 745-755 |w (DE-627)NLM216296978 |x 1178-6981 |7 nnns |
| 773 | 1 | 8 | |g volume:13 |g year:2021 |g day:01 |g pages:745-755 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.2147/CEOR.S317078 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 13 |j 2021 |b 01 |h 745-755 | ||