Cost-effectiveness analysis of apixaban compared to other direct oral anticoagulants for prevention of stroke in Austrian atrial fibrillation patients

Walter, E.; Voit, M.; Eichhober, G.

doi:10.1080/14737167.2020.1798233

Cited by 7 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this option, the description of health states was based upon the EuroQol-5 Dimensions-3 levels (EQ-5D-3L) questionnaire and health utilities were derived building upon choice-based methods, thereby producing the endpoint quality-adjusted life years (QALYs). For the health states, ''disabling stroke'' and ''treated AF'', the utility decrements were calculated using utilities reported by Walter et al [18] for AF and Ali et al [19] for disabling stroke and then finally adjusted for age and population norms for EQ-5D-3L according to Szende et al [20].…”

Section: Survival Extrapolationmentioning

confidence: 99%

Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk

et al. 2023

View full text Add to dashboard Cite

Introduction: In the randomized PARTNER 3 trial, transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device significantly reduced a composite of all-cause death, stroke, and rehospitalization, compared with surgical aortic valve replacement (SAVR), in patients with severe symptomatic aortic stenosis and low risk of surgical mortality. Furthermore, TAVI has been shown to be cost-effective in low-risk patients, compared with SAVR, in a number of countries. This study aimed to determine the cost-effectiveness of TAVI with SAPIEN 3 versus SAVR in Germany. Methods: A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted for the German context using the German Statutory Health Insurance perspective. The model had a lifetime horizon. The cost-utility analysis estimated changes in direct healthcare costs as well as survival and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. Results: TAVI with SAPIEN 3 increased qualityadjusted life years (QALYs) by ? 0.72 at an increased cost of €8664 per patient. The incremental cost-effectiveness/QALY ratio was €12,037, which fell below that of other cardiovascular interventions in use in Germany. The

show abstract

Section: Survival Extrapolationmentioning

confidence: 99%

Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Only one study [ 10 ] evaluated the cost effectiveness of rate control strategies in AF management in HIC. Of the 32 studies that evaluated strategies for stroke prevention in HIC, 14 were from North America [ 8 , 25 , 26 , 28 , 29 , 31 , 32 , 37 – 39 , 44 , 46 – 48 ], 13 from Europe [ 18 , 19 , 22 – 24 , 27 , 30 , 33 – 35 , 40 , 42 , 45 ], 4 from Asia [ 21 , 29 , 43 , 47 ] and 1 from Oceania [ 28 ]. The proportion of male sex (52–77%) was higher than the female sex in most of the studies.…”

Section: Resultsmentioning

confidence: 99%

“…Studies from the UK used the National Institute of Health and Clinical Excellence (NICE) recommended threshold between £20,000 and £30,000 per QALY [ 40 , 60 , 62 ]. Other studies in Europe adopted the NICE recommendation but expressed values in Euros or US$ [ 18 , 19 , 22 – 24 , 27 , 30 , 34 , 35 , 40 , 42 , 45 ]. Some other studies used government-led guidelines [ 22 , 34 , 44 ], or one to three times the gross domestic product per capita (GDP) of the country citing the World Health Organization [ 10 , 21 , 43 , 47 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…Some other studies used government-led guidelines [ 22 , 34 , 44 ], or one to three times the gross domestic product per capita (GDP) of the country citing the World Health Organization [ 10 , 21 , 43 , 47 , 56 ]. The sample size was hypothetical for most studies, between 1000 and 10,000 patients, while some studies used the sample size from observational data repository or randomised-control trials, with sample sizes ranging from 231 to 212,459 patients [ 10 , 21 , 34 , 42 , 50 , 54 , 56 , 58 , 61 , 65 ]. The patients average age was 67 (55–78) years (see Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review

et al. 2023

View full text Add to dashboard Cite

Background Atrial fibrillation (AF) remains the most common form of cardiac arrhythmia. Management of AF aims to reduce the risk of stroke, heart failure and premature mortality via rate or rhythm control. This study aimed to review the literature on the cost effectiveness of treatment strategies to manage AF among adults living in low-, middle- and high-income countries. Methods We searched MEDLINE (OvidSp), Embase, Web of Science, Cochrane Library, EconLit and Google Scholar for relevant studies between September 2022 and November 2022. The search strategy involved medical subject headings or related text words. Data management and selection was performed using EndNote library. The titles and abstracts were screened followed by eligibility assessment of full texts. Selection, assessment of the risk of bias within the studies, and data extraction were conducted by two independent reviewers. The cost-effectiveness results were synthesised narratively. The analysis was performed using Microsoft Excel 365. The incremental cost effectiveness ratio for each study was adjusted to 2021 USD values. Results Fifty studies were included in the analysis after selection and risk of bias assessment. In high-income countries, apixaban was predominantly cost effective for stroke prevention in patients at low and moderate risk of stroke, while left atrial appendage closure (LAAC) was cost effective in patients at high risk of stroke. Propranolol was the cost-effective choice for rate control, while catheter ablation and the convergent procedure were cost-effective strategies in patients with paroxysmal and persistent AF, respectively. Among the anti-arrhythmic drugs, sotalol was the cost-effective strategy for rhythm control. In middle-income countries, apixaban was the cost-effective choice for stroke prevention in patients at low and moderate risk of stroke while high-dose edoxaban was cost effective in patients at high risk of stroke. Radiofrequency catheter ablation was the cost-effective option in rhythm control. No data were available for low-income countries. Conclusion This systematic review has shown that there are several cost-effective strategies to manage AF in different resource settings. However, the decision to use any strategy should be guided by objective clinical and economic evidence supported by sound clinical judgement. Registration CRD42022360590. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01276-5.

show abstract

“…Studies from several other countries have shown the cost effectiveness of apixaban over other DOACs and warfarin for stroke prevention in atrial fibrillation [15][16][17][18][19]. Lower risk of major bleeding and ischemic stroke with use of apixaban in comparison to rivaroxaban adds to the increasing popularity of apixaban for thromboprophylaxis in atrial fibrillation/flutter [20,21].…”

Section: Multi-organ Dysfunctionmentioning

confidence: 99%

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

et al. 2022

View full text Add to dashboard Cite

Background: Increasing reports suggest the safe use of direct oral anticoagulants (DOACs) in electrical cardioversion. The aim of this study was to assess the trends and 30-day outcomes associated with anticoagulation for cardioversion. Methods:Patients who underwent electrical cardioversion from January 2015 to October 2020 with a 30-day follow-up were included; and outcomes including stroke, transient ischemic attack, intracranial hemorrhage (ICH), and major gastrointestinal bleeding were recorded.Results: Of the 515 patients, 351 (68%) were men and 164 (32%) were women, with a mean CHA 2 DS 2 VASc score of 2.6 ± 1.6. Outpatient apixaban use increased from 10% in 2015 to 46% in 2020 (P < 0.001) with a decline in the use of warfarin from 24% in 2015 to 10% in 2020 (P = 0.023). Apixaban use peri-procedurally for cardioversion increased from 32% in 2015 to 35% in 2020 (P = 0.317), while warfarin use decreased from 23% in 2015 to 14% in 2020 (P = 0.164). At discharge, apixaban prescriptions increased from 21% in 2015 to 61% in 2020 (P < 0.001), while warfarin prescriptions declined from 30% in 2015 to 13% in 2020 (P = 0.009). No ICH was recorded in the 30 days after cardioversion. Ischemic stroke occurred in four (0.7%) patients with one (0.29%) of the 338 patients on a DOAC, one (0.8%) of the 124 patients on warfarin and two (5.5%) of the 36 patients not receiving anticoagulation post cardioversion. There were seven (1%) major gastrointestinal bleeding events in patients on oral anticoagulation, of which four (3%) were on warfarin and three (0.8%) were on DOACs. Conclusions:Our study shows the increasing and safe use of DOACs for the purpose of cardioversion. The rates of 30-day ischemic stroke post cardioversion were low and only occurred in patients admitted in the intensive care unit.

show abstract

Cost-effectiveness analysis of apixaban compared to other direct oral anticoagulants for prevention of stroke in Austrian atrial fibrillation patients

Cited by 7 publications

References 26 publications

Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk

Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk

Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review

Trends and Outcomes of Oral Anticoagulation With Direct Current Cardioversion for Atrial Fibrillation/Flutter at an Academic Medical Center

Contact Info

Product

Resources

About