Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries

BackgroundSeasonal influenza infection is primarily caused by circulation of two influenza A strain subtypes and strains from two B lineages that vary each year. Trivalent influenza vaccine (TIV) contains only one of the two B-lineage strains, resulting in mismatches between vaccine strains and the predominant circulating B lineage. Quadrivalent influenza vaccine (QIV) includes both B-lineage strains. The objective was to estimate the cost-utility of introducing QIV to replace TIV in Germany.MethodsAn individual-based dynamic transmission model (4Flu) using German data was used to provide realistic estimates of the impact of TIV and QIV on age-specific influenza infections. Cases were linked to health and economic outcomes to calculate the cost-utility of QIV versus TIV, from both a societal and payer perspective. Costs and effects were discounted at 3.0 and 1.5 % respectively, with 2014 as the base year. Univariate and probabilistic sensitivity analyses were conducted.ResultsUsing QIV instead of TIV resulted in additional quality-adjusted life-years (QALYs) and cost savings from the societal perspective (i.e. it represents the dominant strategy) and an incremental cost-utility ratio (ICUR) of €14,461 per QALY from a healthcare payer perspective. In all univariate analyses, QIV remained cost-effective (ICUR <€50,000). In probabilistic sensitivity analyses, QIV was cost-effective in >98 and >99 % of the simulations from the societal and payer perspective, respectively.ConclusionThis analysis suggests that QIV in Germany would provide additional health gains while being cost-saving to society or costing €14,461 per QALY gained from the healthcare payer perspective, compared with TIV.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0443-7) contains supplementary material, which is available to authorized users.

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“…As an estimate, we applied the €50,000 per QALY threshold that is commonly used in European and German economic evaluations [24, 25]. …”

Section: Methodsmentioning

confidence: 99%

Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model

et al. 2016

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“…As an estimate, we applied the €50,000/QALY threshold that is commonly used in other economic evaluations relevant to Germany. [32][33][34]…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Cost-effectiveness of the recombinant zoster vaccine in the German population aged ≥60 years old

Oorschot

Anastassopoulou

Nautrup³

et al. 2018

Human Vaccines & Immunotherapeutics

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Each year, around 300,000 Herpes Zoster (HZ) cases are observed in the German population, resulting in costs over €182 million to society. The objective of this study was to estimate the potential public health and economic impact of the new Adjuvanted Recombinant Zoster Vaccine (RZV, Shingrix) in the German population ≥ 60 years of age (YOA) and to identify the optimal age of vaccination. We used a static, multi-cohort Markov model that followed a hypothetical cohort of 1 million people ≥ 60 YOA life-long after vaccination using German-specific inputs. Both costs and outcomes were discounted at 3%, the incremental cost-effectiveness ratio (ICER) was calculated based on the societal perspective. The coverage of RZV was set at 40% with a second-dose compliance of 70%. Vaccinating the population aged ≥ 60 YOA would result in 45,000 HZ cases avoided, 1,713 quality-adjusted life years (QALYs) gained at a total cost of approximately €63 million compared to 38,000 cases avoided, 1,545 QALYs gained at a total cost of approximately €68 million in the population ≥ 70 YOA. This would result in an ICER of approximately €37,000 and €44,000/QALY, for the age cohort ≥ 60 and ≥ 70 YOA, respectively. Scenario analyses demonstrated that vaccinating at age 60 or 65 YOA would show greater public health impact and would result in the lowest observed ICER compared to vaccinating at 70 YOA. In conclusion, starting vaccination with RZV in the German population ≥ 60 YOA would demonstrate the best value from a public health and economic standpoint.[Figure: see text].

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“…All publications except four used a lifetime horizon for the included subjects: two of them used a time horizon of 20 years [25, 34], one study used 30 years [32], and one study used a 1-year period and a 10-year period [25]. Utilities were generally assigned on the basis of previously published studies.…”

Section: Resultsmentioning

confidence: 99%

“…One study compared apixaban with vitamin K antagonists (VKAs) [19]. Eight studies compared warfarin with apixaban, dabigatran, and rivaroxaban [12, 16, 22, 25, 29–32]. One study compared apixaban with dabigatran [15], and one study compared apixaban with rivaroxaban [13].…”

Section: Resultsmentioning

confidence: 99%

“…War€30,000/QALY[13]SpainApixa vs. Riva€2347/QALY (NHS)Dominant (societal)€30,000/QALY[14]SpainApixa vs. acenocoumarol€13,305/LYG (NHS)€12,765/QALY (NHS)€30,000/QALY[15]SpainApixa vs. Dabi 110 mg€1299/QALY (NHS)Dominant (societal)Apixa vs. Dabi 150 mg€6591/QALY (NHS)€10,676/QALY (societal)€30,000/QALY[16]UKDabi was dominant vs. Riva, Apixa, and War£25,000/QALY[17]The Netherlands/UKThe Netherlands:Riva: DominatedApixa: €13,024/QALYDabi: €14,626/QALYUK:Riva: DominatedApixa: DominatedDabi: €11,172/QALY vs. coumarin derivatives€20,000/QALY and €36,000/QALY[18]BelgiumApixa vs. aspirin€7334/QALY€30,000/QALY[19]The NetherlandsApixa vs. VKAs€10,576/QALY€20,000/QALY[20]SwedenApixa vs.War: SEK 41,453/QALYAspirin: SEK 41,453/QALYFor War and aspirin, above SEK 35,000 and SEK 45,000 per QALY, respectively[21]FranceAspirin, Dabi, and Riva were dominated by WarApixa vs. War: €12,227/QALY€30,000/QALY[22]NorwaySequential Dabi: €15,920/QALYApixa: €18,955/QALYRiva: €29,990/QALYDabi 110 mg: €66,121/QALYvs. War€79,000/QALY (NOK 588,000/QALY)[23]UKApixa vs. War: £11,909/QALYAspirin: £7196/QALY£20,000/QALY[24]UKApixaban vs. Dabi 110: £4497/QALYDabi 150: £9611/QALYRiva: £5305/QALY£20,000/QALY[25]…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Literature Review on the Cost-Effectiveness of Apixaban for Stroke Prevention in Non-valvular Atrial Fibrillation

Pinyol¹,

Cepeda

Roldán

et al. 2016

Cardiol Ther

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IntroductionEconomic evaluations are becoming increasingly important due to limitations in economic resources, the expense of many new treatments, the need to allocate health spending as effectively as possible, and the need to inform decision makers. Based on the data from the apixaban studies (ARISTOTLE and AVERROES), several economic evaluations have been performed in various countries to demonstrate the efficacy of apixaban versus warfarin and aspirin or other new oral anticoagulants (NOACs) for preventing stroke in patients with non-valvular atrial fibrillation (NVAF).The aim of this study was to perform a systematic literature review of published economic evaluations with apixaban in the indication of stroke prevention in patients with NVAF.MethodsA search in PubMed, Cochrane Library, Google Scholar, and Index Medicus Español was conducted in June 2015. Inclusion and exclusion criteria were established. The main characteristics were recorded for all relevant articles after being reviewed. In addition, a weighted version of the Drummond’s checklist was used to further assess the quality of the selected studies.ResultsAfter review, 26 cost-effectiveness analyses through Markov models were included; the identified economic evaluations represent different willingness-to-pay (WTP) thresholds, discount rates, medical costs, and healthcare systems. Apixaban was compared with warfarin/acenocoumarol in 7 of them (27%), with warfarin/NOACs in 14 (54%), with aspirin in 2 (8%), and with warfarin/aspirin in 3 (11%). Models were conducted from Europe (69%), USA (23%), Australia (4%), and Latin America (4%). All models reported cost/quality-adjusted life years (QALYs) gained, 92% reported using a payer perspective, and 8% using a societal perspective; the median quality score of the selected studies was 89 (out of 119), with a range of 55–103. In models performed in Europe, incremental cost-effectiveness ratios (ICERs) of apixaban versus warfarin ranged from €5607/QALY to €57,245/QALY, while ICERs versus aspirin ranged from being dominant to €7334/QALY. In models carried out in the USA, ICERs of apixaban versus warfarin ranged from being dominant to $93,063/QALY.ConclusionDifferent cost-effectiveness analyses suggest that apixaban is a cost-effective therapeutic option according to the WTP thresholds used in countries where cost-effectiveness analyses, were performed.FundingBMS and Pfizer.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-016-0066-2) contains supplementary material, which is available to authorized users.

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Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban and apixaban in patients with non-valvular atrial fibrillation across countries

Cited by 37 publications

References 49 publications

Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model

Cost-Utility of Quadrivalent Versus Trivalent Influenza Vaccine in Germany, Using an Individual-Based Dynamic Transmission Model

Cost-effectiveness of the recombinant zoster vaccine in the German population aged ≥60 years old

A Systematic Literature Review on the Cost-Effectiveness of Apixaban for Stroke Prevention in Non-valvular Atrial Fibrillation

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