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Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings.

Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings.

Authors :
de Jong LA
Groeneveld J
Stevanovic J
Rila H
Tieleman RG
Huisman MV
Postma MJ
van Hulst M
Source :
PloS one [PLoS One] 2019 Sep 17; Vol. 14 (9), pp. e0222658. Date of Electronic Publication: 2019 Sep 17 (Print Publication: 2019).
Publication Year :
2019

Abstract

Introduction: Randomized clinical trials (RCTs) and real-world data (RWD) in patients with atrial fibrillation have shown that-compared to vitamin K antagonists (VKAs)-non-VKA oral anticoagulants (NOACs) are at least as effective in the prevention of ischaemic stroke, while decreasing the risk of bleeding.<br />Objective: We aim to evaluate the cost-effectiveness of the NOAC apixaban versus other NOACs (dabigatran, edoxaban and rivaroxaban) and VKA, for stroke prevention in patients with atrial fibrillation by including the available data both from RCT and real-world analyses of all NOACs into one integrative previously published model.<br />Methods: The model was updated to the current Dutch healthcare situation. The incremental cost-effectiveness ratio was calculated using either efficacy/effectiveness and safety data derived from a network meta-analysis (NMA) synthesizing NOAC RCTs or RWD. We conducted a systematic literature search to identify eligible publication to best inform the RWD-based analysis. Additional sensitivity and scenario analyses were conducted to test the robustness of the outcomes.<br />Results: In the NMA-based analysis, apixaban appeared to be cost-effective compared to VKA (€3,506 per quality adjusted life-year) and dominant (cost-saving and more effective) over dabigatran 110 mg, dabigatran 150 mg, edoxaban and rivaroxaban. In the RWD-based analysis, apixaban was dominant over all other anticoagulants. In the scenario analysis apixaban appeared to be not cost-effective compared to dabigatran 150 mg, when using equal event-unrelated treatment discontinuation rates for each drug. In all other scenarios apixaban is cost-effective or cost-saving compared to VKA and other NOACs.<br />Conclusion: Based on RCTs as well as RWD, we conclude that apixaban is generally cost-effective or even cost-saving (less costly and more effective) compared to VKA and other NOACs in the overall population of patients with atrial fibrillation.<br />Competing Interests: Maarten J. Postma has received grants and honoraria from all companies developing, producing, and marketing non-vitamin K oral anticoagulants (NOACs)—Boehringer Ingelheim, Pfizer, Bayer, Daiichi-Sankyo and Bristol-Myers Squibb—both in relation to NOACs and related to other topics. He has also received grants and honoraria from other companies fully unrelated to the subject matter of this paper, namely GSK, Astra Zeneca, Biomarin, MSD, Merck, Sanofi, and Novartis. In addition, he is adviser to the consultancy company Asc Academics and holds stock in Ingress Health. Marinus van Hulst has no current competing interests. However, in the past he received travel grants and speaker honoraria from Bayer, and consulted for Boehringer Ingelheim. Robert G. Tieleman has received research grants and personal fees from Boehringer Ingelheim, Pfizer, Bayer, and Bristol-Myers Squibb. Menno V. Huisman has obtained grants from ZonMW Dutch Healthcare Fund as well as grants and personal fees from Boehringer-Ingelheim, Pfizer-BMS, Bayer Health Care, Aspen, and Daiichi-Sankyo outside the submitted work. Harrie Rila and Jelena Stevanovic are employees of Bristol-Myers Squibb without ownership of stock in Bristol-Myers Squibb Company. They were involved with the start of the research but did not influence the results and discussion. Lisa A. de Jong and Jessie Groeneveld have no conflicts of interest with relation to the subject. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Details

Language :
English
ISSN :
1932-6203
Volume :
14
Issue :
9
Database :
MEDLINE
Journal :
PloS one
Publication Type :
Academic Journal
Accession number :
31527894
Full Text :
https://doi.org/10.1371/journal.pone.0222658