Economic Evaluation of Apixaban for the Prevention of Stroke in Non-Valvular Atrial Fibrillation in the NetherlandsReportar como inadecuado




Economic Evaluation of Apixaban for the Prevention of Stroke in Non-Valvular Atrial Fibrillation in the Netherlands - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

Stroke prevention is the main goal of treating patients with atrial fibrillation AF. Vitamin-K antagonists VKAs present an effective treatment in stroke prevention, however, the risk of bleeding and the requirement for regular coagulation monitoring are limiting their use. Apixaban is a novel oral anticoagulant associated with significantly lower hazard rates for stroke, major bleedings and treatment discontinuations, compared to VKAs.

Objective

To estimate the cost-effectiveness of apixaban compared to VKAs in non-valvular AF patients in the Netherlands.

Methods

Previously published lifetime Markov model using efficacy data from the ARISTOTLE and the AVERROES trial was modified to reflect the use of oral anticoagulants in the Netherlands. Dutch specific costs, baseline population stroke risk and coagulation monitoring levels were incorporated. Univariate, probabilistic sensitivity and scenario analyses on the impact of different coagulation monitoring levels were performed on the incremental cost-effectiveness ratio ICER.

Results

Treatment with apixaban compared to VKAs resulted in an ICER of €10,576 per quality adjusted life year QALY. Those findings correspond with lower number of strokes and bleedings associated with the use of apixaban compared to VKAs. Univariate sensitivity analyses revealed model sensitivity to the absolute stroke risk with apixaban and treatment discontinuations risks with apixaban and VKAs. The probability that apixaban is cost-effective at a willingness-to-pay threshold of €20,000-QALY was 68%. Results of the scenario analyses on the impact of different coagulation monitoring levels were quite robust.

Conclusions

In patients with non-valvular AF, apixaban is likely to be a cost-effective alternative to VKAs in the Netherlands.



Autor: Jelena Stevanović , Marjolein Pompen, Hoa H. Le, Mark H. Rozenbaum, Robert G. Tieleman, Maarten J. Postma

Fuente: http://plos.srce.hr/



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