Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 745-755 |
| Number of pages | 11 |
| Journal | ClinicoEconomics and Outcomes Research |
| Volume | 13 |
| DOIs | |
| Publication status | Published - 2021 |
| MoE publication type | A1 Journal article-refereed |
Funding
TH and ES are partners and employees, and CA is an employee of ESiOR Oy, which was commissioned by Pfizer Oy to perform this study. ESiOR has carried out commissioned studies and health-economic analyses for several other pharmaceutical companies, food industry companies, device companies, research groups, health care organizations, and hospitals. ML is an employee of Aalto University. PE, SS and MK are employees of Pfizer Oy. This study was sponsored by Pfizer and Bristol Myers Squibb. Medical Writing support was provided by Taru Hallinen at ESiOR Oy and was funded by Pfizer and Bristol Myers Squibb. The authors report no other conflicts of interest in this work.
Keywords
- apixaban
- cost-utility
- dabigatran
- economic evaluation
- rivaroxaban
- warfarin
- STROKE PREVENTION
- DABIGATRAN ETEXILATE
- SYSTEMIC EMBOLISM
- RIVAROXABAN
- EDOXABAN
- SAFETY
- IMPACT
- RISK
- CARE
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