The Cost-Effectiveness Of Novel Oral Anticoagulants For The Prevention Of Stroke In Atrial Fibrillation In England And Wales

Abstract

To identify published cost-effectiveness analyses and health technology assessment (HTA) submissions for treatments in chronic heart failure (CHF) to inform future cost-effectiveness modeling in CHF. MethOds: A systematic review was performed. Literature searches were conducted in MEDLINE, EMBASE, EconLit, and the Cochrane Library, with supplementary hand searching of conferences and HTA websites. Eligible studies had to report on cost-effectiveness outcomes in adults with CHF and/or heart failure with reduced ejection fraction, treated with angiotensin-converting enzyme inhibitors, beta-blockers, mineralocorticoid receptor antagonists, angiotensin receptor blockers, or ivabradine. Results: Sixty-six publications met the inclusion criteria, representing 63 distinct analyses. Of these, 53 reported their MethOds: 20 were statistical analyses of individual patient data, while 33 used decision-analytic modeling. Structures were most commonly described as being Markov (n= 27) but the methods were heterogeneous. The health states most frequently employed were 'alive' or 'dead', with outcomes such as hospitalization or New York Heart Association (NYHA) class distribution most commonly considered as a partition of the 'alive' state. Other health states considered were often based on NYHA class, hospitalizations, and major CV events. Different approaches to modeling the effects of interventions on mortality were used; treatment effects were applied to cardiovascular (CV) mortality and all-cause mortality in nine and 20 studies (among the 33 decision-analytic models), respectively. Across included studies, the time horizon ranged from within-trial to lifetime. Outcomes were frequently sensitive to baseline risks of mortality and hospitalization, relative efficacy of interventions, and unit costs of interventions. cOnclusiOns: The studies identified were heterogeneous with respect to their approaches; this may be due to the preference of payers in different jurisdictions. However, the identified literature suggests mortality and hospitalization are the key determinants of the cost-effectiveness of treatment for CHF.

Real-world cost-effectiveness of rivaroxaban and apixaban vs VKA in stroke prevention in non-valvular atrial fibrillation in the UK

“…This confirms previous results submitted to NICE [12,13], but also results published later, in the UK in particular [46], but also in France [15]. This latter paper used a similar approach for rivaroxaban, considering only RWE inputs (characteristics, clinical event rates, treatment effect, discontinuation, switch rates, utility, resource use and unit costs for all events), and led to a similar conclusion.…”

Availability of secondary prevention services after stroke in Europe: An ESO/SAFE survey of national scientific societies and stroke experts

“…However, inequalities in secondary stroke prevention depended largely upon national income, representing a major societal challenge. Even here, identification of key gaps in care may enable targeting of limited resources to the most cost-effective interventions, including increasing availability of advanced interventions that are cost effective (DOACs 14 ) or likely to be (prolonged cardiac monitoring, 13 PFO closure 15,16 ). Where feasible, gaps in interventions may be increased through healthcare policy, clinical guidelines and intervention-specific reimbursement, including strategic investment in training and development of capacity for more technical interventions.…”