Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain

Barón-Esquivias, Gonzalo; Albaladejo, Ginés Escolar; Zamorano, José Luís; Nicolás, Lourdes Betegón; Fontcuberta, C. Canal; Salas-Cansado, Marina de; Rubio-Rodríguez, Darío; Rubio-Terrés, Carlos

doi:10.1016/j.rec.2014.08.010

Cited by 17 publications

(34 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 A hypothetical cohort of 1000 patients with an average age of 73 years (median age in ROCKET AF trial)16 and NVAF at moderate 1000 patients with an average age of 73 years (median age in ROCKET AF trial) 16 and NVAF at moderate (CHADS 2 score =2) to high risk (CHADS 2 score ≥3), enters the model and receives chronic treatment with rivaroxaban (20 mg daily) or an adjusted dose of acenocoumarol with a target INR of 2.5 (in the analysis a dose of 5 mg daily was considered, the daily dose recommended by the World Health Organization). 19 In both cases, the patients were treated with aspirin (ASA) in the event of discontinuing the initial treatment.…”

Section: Economic Modelmentioning

confidence: 99%

“…Three types of costs were considered: that of acquiring the anticoagulant drugs, 27 that of administration/ monitoring of them and that of the events in the patient with NVAF with each treatment (Table 3). 19,28,29 The drug costs (public prices) were applied with a reduction of 7.5% (rivaroxaban) or of 15% (acenocoumarol, acetylsalicylic acid) according to Spanish law. When patients are initiated on acenocoumarol therapy, it is recommended that they visit their physician regularly to make the dose adjustments required to maintain the target INR of 2.5 (2.0 to 3.0).…”

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

“…15,30 To do this, as in other previously published Spanish studies, it was assumed that the annual cost is about €320 30 and the unit cost of the monitoring visit is half the cost of the routine visit to the general practitioner (Table 3). 19,29 For acetylsalicylic acid and rivaroxaban the model considers that patients would visit their GP twice a year (range: 0 to 8 visits per year) as no monitoring is required for these therapies. 15 The costs of events of the NVAF were also obtained from Spanish sources.…”

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

“…15 The costs of events of the NVAF were also obtained from Spanish sources. 19,28,29 All costs are JHEOR 2016;4(1):19-34 | www.jheor.org presented in Euros (€) of 2015. An annual discount rate of 3.0% was applied for the health costs and effects according to current recommendations in Spain.…”

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

See 3 more Smart Citations

Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain

Rubio-Terrés

Codes²,

Rubio-Rodríguez

et al. 2016

JHEOR

Self Cite

View full text Add to dashboard Cite

Objective: The aim of this study was to evaluate, from the Spanish National Health System perspective, the cost-effectiveness of rivaroxaban (20 mg/day) versus use of acenocoumarol (5 mg/day) for the treatment of patients with non-valvular atrial fibrillation (NVAF) at moderate to high risk for stroke. Methods: A Markov model was designed and populated with local cost estimates, efficacy and safety of rivaroxaban in stroke prevention in NVAF compared with adjusted-dose warfarin clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. Results: Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.289 vs. 0.300 events), intracranial bleeds (0.051 vs. 0.067), and myocardial infarctions (0.088 vs. 0.102) per patient compared with acenocoumarol. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.041 life-threatening events per patient, and increases of 0.103 life-years and 0.155 quality-adjusted lifeyears (QALYs) versus acenocoumarol treatment. This resulted in an incremental cost-effectiveness ratio of €7045 per QALY and €10 602 per life-year gained. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with acenocoumarol in 89.4% of cases should a willingness-to-pay threshold of €30 000/QALY gained be considered. Conclusions: The present analysis suggests that rivaroxaban is a cost-effective alternative to acenocoumarol therapy for the prevention of stroke and systemic embolisms in patients with NVAF in the Spanish healthcare setting.

show abstract

Section: Economic Modelmentioning

confidence: 99%

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

Section: Cost Of Drugs and Eventsmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain

Rubio-Terrés

Codes²,

Rubio-Rodríguez

et al. 2016

JHEOR

Self Cite

View full text Add to dashboard Cite

show abstract

“…These new generation drugs do not require periodic laboratory-supervised monitoring and interact less with other drugs and foods (3,4). However, their use in comparison with traditional oral anticoagulants involves economic costs (5,6). …”

Section: Introductionmentioning

confidence: 99%

Implications of apixaban for dental treatments

Curto

Albaladejo

2016

J Clin Exp Dent

View full text Add to dashboard Cite

BackgroundAnticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Recently, new oral anticoagulants have been introduced as alternatives to warfarin and acenocoumarol. In Europe, the European Medicines Agency has approved dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent.Material and MethodsA literature search was conducted through November 2015 for publications in the ISI Web of Knowledge, PubMed, Scopus and Cochrane Library using the keywords “apixaban”, “rivaroxaban”, “dabigatran”, “new oral anticoagulants”, “dental treatment” and “dental implications”. We included studies published in English and Spanish over the last 10 years.ResultsApixaban has been recently introduced in the daily medical practices for the control of thromboembolism. The number of patients taking apixaban is increasing. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments. It is important for dentists to have a sound understanding of the mechanisms of action and management guidelines for patients taking new oral anticoagulants.ConclusionsThe dentist should consider carefully the management of patients on apixaban. This paper sets out a clinical guidance of dental practitioners treating these patients. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring apixaban. Key words:Apixaban, new oral anticoagulants, dental treatment.

show abstract

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

View full text Add to dashboard Cite

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.

show abstract

Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain

Cited by 17 publications

References 44 publications

Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain

Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain

Implications of apixaban for dental treatments

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

Contact Info

Product

Resources

About