Pharmacoeconomic Assessment Of Apixaban Versus Standard Of Care For The Prevention Of Stroke In Italian Non-Valvular Atrial Fibrillation Patients

Abstract

clinical response to treatment and the number of QALYs per patient accrued during the study. Only direct medical costs (drug acquisition, administration and hospitalization costs) were incorporated in the model, as the analysis was conducted from a third-party payer perspective. With respect to administration cost, two alternative scenarios were considered in the base case analysis: administration in day-case unit and administration in the hospital outpatient department. Probabilistic sensitivity analysis was conducted. Primary outcomes were quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Results: In the base case analysis, QALYs of FCM treated patients were higher compared to no iron treated patients by 0.04 QALYs. The total 24-week cost of FCM was higher by € 969 and € 204, it the two scenarios respectively. This difference was mainly attributed to the administration cost and drug acquisition cost related to FMC. Incremental cost effectiveness analysis showed that treatment with FCM was a cost-effective option resulting in an ICER of € 25,506 and € 5,368 per QALY gained in the scenarios respectively. Probabilistic sensitivity analysis revealed that FCM was likely to be cost-effective in over 80% and 99% in the two scenarios respectively, at a willingness-to-pay threshold of € 34,000 per QALY gained. ConClusions: Ferric carboxymaltose may be a cost -effective option in relation to no iron treatment for the management of iron deficiency of HF patients in Greece.objeCtives: Non-adherence to drug therapy poses a significant problem in the treatment of patients with presumed resistant hypertension (RH). It has been shown that therapeutic drug monitoring (TDM) is a useful tool for detecting non-adherence and identifying barriers to treatment adherence, leading to effective blood pressure (BP) control. However, the cost-effectiveness of TDM in the management of RH has not been investigated. Methods: A Markov model was used to evaluate life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios in RH patients receiving either TDM optimized therapy or standard best medical therapy. The model ran from the age of 30 to 100 years or death, using a cycle length of 1 year. Efficacy of TDM was modeled by reducing risk of hypertension-related morbidity and mortality. Cost analyses were performed from a payer's perspective. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the age group of 60-year olds, TDM gained 1.07 QALYs in men and 0.97 QALYs in women at additional costs of € 3,854 and € 3,922, respectively. Given a willingness-to-pay threshold of € 35,000 per QALY gained, the probability of TDM being cost-effective was ≥ 95% in all age groups from 30 to 90 years. Results were influenced mostly by the frequency of TDM testing, the rate of non-responders to TDM, and the magnitude of effect of TDM on BP. ConClusions: Therapeutic drug monitoring presents a potentialy highly cost-effective health care intervention in patie...

Analysis of the Introduction in Clinical Practice of New Oral Anticoagulants in Local Health Agency BT: Translation of the Clinical Trial Data to a Local Health Care Area

“…The average cost of hospitalizations for the patients treated with VKAs was 353.41 euros in 2017 and 318.67 euros in 2018.Considering the data of 2018, for patients adhering to long-term therapy, the total direct health cost for the patients treated with NOACs was 835.02 euros, while for the patients treated with VKAs was 337.10 euros. This difference is fully compensated because VKAs treatment requires continuous INR monitoring and the cost is around 380 euros per year, as reported by Pradelli et al [ 58 ]. Thus, the total cost for the treated patients with VKAs was 717.10 euros ( Figure 4 ).…”