Oral Antiplatelet Therapy in Secondary Prevention of Cardiovascular Events

Heeg, Bart; Damen, Joep; Hout, Ben van

doi:10.2165/00019053-200725120-00007

Cited by 26 publications

(22 citation statements)

References 13 publications

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“…The cost of treating subsequent ACS events (long term and transient) were calculated using the NHS reference costs [35] and the cost of follow up was obtained from Heeg et al [36]. The daily cost of rehabilitation from an ACS event was calculated from the NHS reference costs and the duration of rehabilitation was based on clinical opinion.…”

Section: Cost-effectiveness Evidencementioning

confidence: 99%

Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

et al. 2015

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As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures rivaroxaban (Xarelto, Bayer) to submit evidence of the clinical and cost-effectiveness of rivaroxaban for the prevention of adverse outcomes in patients after the acute management of acute coronary syndrome (ACS). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost-effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from a randomised, double-blind, phase III, placebo-controlled trial of rivaroxaban (either 2.5 mg or 5 mg twice daily) in patients with recent ACS (unstable angina, non-ST segment elevation myocardial infarction [NSTEMI] or ST segment elevation myocardial infarction [STEMI]). In addition, all patients received antiplatelet therapy (aspirin alone or aspirin and a thienopyridine either as clopidogrel [approx. 99%] or ticlopidine [approx. 1%] according to national or local guidelines). The higher dose of rivaroxaban (5 mg twice daily) did not form part of the marketing authorisation. A post-hoc sub group analysis of the licensed patients who had ACS with elevated cardiac biomarkers (that is, patients with STEMI and NSTEMI) without prior stroke or transient ischaemic stroke showed that compared with standard care, the addition of rivaroxaban (2.5 mg twice daily) to existing antiplatelet therapy reduced the composite endpoint of cardiovascular mortality, myocardial infraction or stroke but increased the risk of major bleeding and intracranial haemorrhage. However, there were a number of limitations in the evidence base which warrant caution in its interpretation. In particular, the evidence may be confounded due to the post-hoc subgroup analysis, modified intention to treat analyses, high dropout rates and missing vital status data. Results from the company's economic evaluation showed that the deterministic incremental cost-effectiveness ratio (ICER) for rivaroxaban in combination with aspirin plus clopidogrel or with aspirin alone compared with aspirin plus clopidogrel or aspirin alone was £6,203 per quality adjusted life year (QALY) gained. In contrast, the ERG's preferred base case estimate was £5,622 per QALY gained. The ICER did not rise above £10,000 per QALY gained in any of the sensitivity analyses undertaken by the ERG, although the inflexibility of the company's economic model precluded the ERG from formally undertaking all desired exploratory analyses. As such, only a crude exploration of the impact of additional bleeding events could be undertaken. The NICE Appraisal Committee concluded that the ICERs presented were all within the range that could be considered cost-effective and that the results of the ERG's exploratory sensitivity and scenario analyses suggested that the IC...

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Section: Cost-effectiveness Evidencementioning

confidence: 99%

Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

et al. 2015

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“…63 Using data from both MI and stroke studies, they also concluded that the combination of ASA and ER dipyridamole for secondary stroke prevention was more cost-effective than ASA alone and, in indirect comparisons, than clopidogrel. 62 …”

Section: Economic Analyses Of Cost-effectiveness Of Antiplatelet Thermentioning

confidence: 99%

Antiplatelet Therapy for Secondary Prevention of Acute Coronary Syndrome, Transient Ischemic Attack, and Noncardioembolic Stroke in an Era of Cost Containment

Kessler

Thomas²,

Kao³

2012

Journal of Investigative Medicine

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Physicians are aware of the profound impact of oral antiplatelet therapy for secondary prevention of acute coronary syndrome (ACS), transient ischemic attack, and noncardioembolic stroke. Numerous clinical studies have compared the benefits of aspirin (ASA) alone with those of combination therapy with extended-release dipyridamole or with those of clopidogrel, with or without ASA, for secondary stroke prevention; and of ASA monotherapy compared with ASA plus clopidogrel combination therapy for secondary prevention in various ACS populations. More recently, ASA plus prasugrel has been compared with ASA plus clopidogrel in a high-risk ACS population. However, given the different treatment modalities and methods used in the various trials, it is difficult to make generalizations as to which therapy is most effective with the lowest risk of bleeding. Further complicating physician's decision making are cost considerations, particularly with the newer oral antiplatelet agents, which are considerably more expensive than ASA. This review provides a brief overview of the clinical data on each of the currently marketed oral antiplatelet agents and the available data on cost-effectiveness for the secondary prevention of ACS, transient ischemic attack, and noncardioembolic stroke.

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“…The cost of a non-vascular death is based on an assumption from another economic model 104 that estimated the cost of dying from unrelated causes to be approximately £250.…”

Section: Summary Of Costs and Resource Use Event Costsmentioning

confidence: 99%

Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (review of Technology Appraisal No. 90): a systematic review and economic analysis

Greenhalgh

Bagust²,

Boland³

et al. 2011

Health Technol Assess

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Oral Antiplatelet Therapy in Secondary Prevention of Cardiovascular Events

Cited by 26 publications

References 13 publications

Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

Rivaroxaban for Preventing Atherothrombotic Events in People with Acute Coronary Syndrome and Elevated Cardiac Biomarkers: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

Antiplatelet Therapy for Secondary Prevention of Acute Coronary Syndrome, Transient Ischemic Attack, and Noncardioembolic Stroke in an Era of Cost Containment

Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events (review of Technology Appraisal No. 90): a systematic review and economic analysis

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