Cargando…

Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation

AIMS: Warfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than wa...

Descripción completa

Detalles Bibliográficos
Autores principales: Dorian, Paul, Kongnakorn, Thitima, Phatak, Hemant, Rublee, Dale A., Kuznik, Andreas, Lanitis, Tereza, Liu, Larry Z., Iloeje, Uchenna, Hernandez, Luis, Lip, Gregory Y.H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104492/
https://www.ncbi.nlm.nih.gov/pubmed/24513791
http://dx.doi.org/10.1093/eurheartj/ehu006
_version_ 1782327266075738112
author Dorian, Paul
Kongnakorn, Thitima
Phatak, Hemant
Rublee, Dale A.
Kuznik, Andreas
Lanitis, Tereza
Liu, Larry Z.
Iloeje, Uchenna
Hernandez, Luis
Lip, Gregory Y.H.
author_facet Dorian, Paul
Kongnakorn, Thitima
Phatak, Hemant
Rublee, Dale A.
Kuznik, Andreas
Lanitis, Tereza
Liu, Larry Z.
Iloeje, Uchenna
Hernandez, Luis
Lip, Gregory Y.H.
author_sort Dorian, Paul
collection PubMed
description AIMS: Warfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than warfarin and aspirin in the ARISTOTLE and AVERROES studies, respectively, and causes less bleeding than warfarin. We evaluated the potential cost-effectiveness of apixaban against warfarin and aspirin from the perspective of the UK payer perspective. RESULTS AND METHODS: A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model. Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs. CONCLUSIONS: Based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively.
format Online
Article
Text
id pubmed-4104492
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-41044922014-07-21 Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation Dorian, Paul Kongnakorn, Thitima Phatak, Hemant Rublee, Dale A. Kuznik, Andreas Lanitis, Tereza Liu, Larry Z. Iloeje, Uchenna Hernandez, Luis Lip, Gregory Y.H. Eur Heart J Basic Science AIMS: Warfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than warfarin and aspirin in the ARISTOTLE and AVERROES studies, respectively, and causes less bleeding than warfarin. We evaluated the potential cost-effectiveness of apixaban against warfarin and aspirin from the perspective of the UK payer perspective. RESULTS AND METHODS: A lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model. Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs. CONCLUSIONS: Based on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively. Oxford University Press 2014-07-21 2014-02-09 /pmc/articles/PMC4104492/ /pubmed/24513791 http://dx.doi.org/10.1093/eurheartj/ehu006 Text en © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Basic Science
Dorian, Paul
Kongnakorn, Thitima
Phatak, Hemant
Rublee, Dale A.
Kuznik, Andreas
Lanitis, Tereza
Liu, Larry Z.
Iloeje, Uchenna
Hernandez, Luis
Lip, Gregory Y.H.
Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title_full Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title_fullStr Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title_full_unstemmed Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title_short Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
title_sort cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation
topic Basic Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104492/
https://www.ncbi.nlm.nih.gov/pubmed/24513791
http://dx.doi.org/10.1093/eurheartj/ehu006
work_keys_str_mv AT dorianpaul costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT kongnakornthitima costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT phatakhemant costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT rubleedalea costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT kuznikandreas costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT lanitistereza costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT liularryz costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT iloejeuchenna costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT hernandezluis costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation
AT lipgregoryyh costeffectivenessofapixabanvscurrentstandardofcareforstrokepreventioninpatientswithatrialfibrillation