Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain
<h4>Aims</h4> A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibri...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020681/?tool=EBI |
| _version_ | 1817992060364390400 |
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| author | Carlos Escobar Cervantes Julio Martí-Almor Alejandro Isidoro Pérez Cabeza Kevin Bowrin Aleix Llorac Moix Mar Genís Gironès David Gasche Aurélie Millier Jean Tardu Mondher Toumi Jean-Baptiste Briere |
| author_facet | Carlos Escobar Cervantes Julio Martí-Almor Alejandro Isidoro Pérez Cabeza Kevin Bowrin Aleix Llorac Moix Mar Genís Gironès David Gasche Aurélie Millier Jean Tardu Mondher Toumi Jean-Baptiste Briere |
| author_sort | Carlos Escobar Cervantes |
| collection | DOAJ |
| description | <h4>Aims</h4> A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. <h4>Methods</h4> All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. <h4>Results</h4> When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. <h4>Conclusion</h4> These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective. |
| first_indexed | 2024-04-14T01:21:35Z |
| format | Article |
| id | doaj.art-46da4a59a6c2409393f102d6268c6b32 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-14T01:21:35Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-46da4a59a6c2409393f102d6268c6b322022-12-22T02:20:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in SpainCarlos Escobar CervantesJulio Martí-AlmorAlejandro Isidoro Pérez CabezaKevin BowrinAleix Llorac MoixMar Genís GironèsDavid GascheAurélie MillierJean TarduMondher ToumiJean-Baptiste Briere<h4>Aims</h4> A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. <h4>Methods</h4> All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. <h4>Results</h4> When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. <h4>Conclusion</h4> These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020681/?tool=EBI |
| spellingShingle | Carlos Escobar Cervantes Julio Martí-Almor Alejandro Isidoro Pérez Cabeza Kevin Bowrin Aleix Llorac Moix Mar Genís Gironès David Gasche Aurélie Millier Jean Tardu Mondher Toumi Jean-Baptiste Briere Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain PLoS ONE |
| title | Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain |
| title_full | Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain |
| title_fullStr | Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain |
| title_full_unstemmed | Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain |
| title_short | Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain |
| title_sort | real world cost effectiveness analysis of noacs versus vka for stroke prevention in spain |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020681/?tool=EBI |
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