Economic evaluation of apixaban for the prevention of stroke in non-valvular atrial fibrillation in the Netherlands

PLoS One. 2014 Aug 5;9(8):e103974. doi: 10.1371/journal.pone.0103974. eCollection 2014.

Abstract

Background: Stroke prevention is the main goal of treating patients with atrial fibrillation (AF). Vitamin-K antagonists (VKAs) present an effective treatment in stroke prevention, however, the risk of bleeding and the requirement for regular coagulation monitoring are limiting their use. Apixaban is a novel oral anticoagulant associated with significantly lower hazard rates for stroke, major bleedings and treatment discontinuations, compared to VKAs.

Objective: To estimate the cost-effectiveness of apixaban compared to VKAs in non-valvular AF patients in the Netherlands.

Methods: Previously published lifetime Markov model using efficacy data from the ARISTOTLE and the AVERROES trial was modified to reflect the use of oral anticoagulants in the Netherlands. Dutch specific costs, baseline population stroke risk and coagulation monitoring levels were incorporated. Univariate, probabilistic sensitivity and scenario analyses on the impact of different coagulation monitoring levels were performed on the incremental cost-effectiveness ratio (ICER).

Results: Treatment with apixaban compared to VKAs resulted in an ICER of €10,576 per quality adjusted life year (QALY). Those findings correspond with lower number of strokes and bleedings associated with the use of apixaban compared to VKAs. Univariate sensitivity analyses revealed model sensitivity to the absolute stroke risk with apixaban and treatment discontinuations risks with apixaban and VKAs. The probability that apixaban is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 68%. Results of the scenario analyses on the impact of different coagulation monitoring levels were quite robust.

Conclusions: In patients with non-valvular AF, apixaban is likely to be a cost-effective alternative to VKAs in the Netherlands.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 4-Hydroxycoumarins / economics
  • 4-Hydroxycoumarins / therapeutic use
  • Aged
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / economics
  • Cost of Illness
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • Fibrinolytic Agents / economics*
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Indenes / economics
  • Indenes / therapeutic use
  • Male
  • Netherlands
  • Pyrazoles / economics*
  • Pyrazoles / therapeutic use*
  • Pyridones / economics*
  • Pyridones / therapeutic use*
  • Stroke / economics
  • Stroke / prevention & control*
  • Vitamin K / antagonists & inhibitors
  • Vitamin K / economics
  • Vitamin K / therapeutic use

Substances

  • 4-Hydroxycoumarins
  • Fibrinolytic Agents
  • Indenes
  • Pyrazoles
  • Pyridones
  • antivitamins K
  • Vitamin K
  • apixaban

Grant support

Prof. Postma received grants, honoraria and travel stipend from GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi, Shire, Pfizer, Novartis, Amgen, Astra Zeneca, Gilead and Boehringer Ingelheim. The funder provided support in the form of salaries for authors [MP and MHR], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.