Cost Effectiveness Analysis Of Apixaban Versus Other Noacs For The Prevention Of Stroke In Italian Non-Valvular Atrial Fibrillation Patients

Abstract

A487ing cardiovascular mortality, myocardial infarction (MI), or stroke among patients with acute coronary syndrome (ACS) compared to clopidogrel but without a significant increase in major bleedings. In Hong Kong, generic clopidogrel was introduced in 2012. This study aimed to evaluate the long-term cost-effectiveness of ticagrelor in ACS patients in Hong Kong (HK) from a public hospital's perspective. Methods: A two-phase Markov model was used to estimate the short-and long-term costeffectiveness measured as cost per quality-adjusted-life-year (QALY) and cost per life-year-gained (LYG) over 1 year, 5 years and patients' lifetime. Direct medical costs were HK-specific and patients' resource use, rate of cardiovascular events (i.e. MI and stroke) and utility data were from published literature. All costs were presented as 2014 figures, cost and effectiveness were both discounted at 3% per annum. Sensitivity analyses were performed to test model robustness. Results: Despite the great difference in the daily drug cost of ticagrelor and generic clopidogrel (US2.8, vs US0.10,1US= 7.8HK), the overall cost of management between the 2 groups remains similar. Our study shows that the incremental cost-effectiveness ratios (ICER) of ticagrelor were reduced substantially from US16,071/LYG and US19,493/ QALY in the first year to US302/LYG and US357/QALY over a lifetime time horizon due to improvements in health outcomes. The ICER values were all cost-effective based on the WHO 3xGDP criteria (GDP 2013= US37,860). The results are sensitive to cost of generic clopidogrel. ConClusions: Treating ACS patients with lifetime use of ticagrelor can potentially reduce the cost of management and increase the cost-effectiveness due to better health outcomes as compared to generic clopidogrel. Ticagrelor therapy appears to be cost-effective both on short-and long-term assessment in the public health care sector of Hong Kong.