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Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Systematic Review of Cost-Effectiveness Models

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  • Brendan L Limone
  • William L Baker
  • Jeffrey Kluger
  • Craig I Coleman

Abstract

Objective: To conduct a systematic review of economic models of newer anticoagulants for stroke prevention in atrial fibrillation (SPAF). Patients and Methods: We searched Medline, Embase, NHSEED and HTA databases and the Tuft’s Registry from January 1, 2008 through October 10, 2012 to identify economic (Markov or discrete event simulation) models of newer agents for SPAF. Results: Eighteen models were identified. Each was based on a lone randomized trial/new agent, and these trials were clinically and methodologically heterogeneous. Dabigatran 150 mg, 110 mg and sequentially-dosed were assessed in 9, 8, and 9 models, rivaroxaban in 4 and apixaban in 4. Warfarin was a first-line comparator in 94% of models. Models were conducted from United States (44%), European (39%) and Canadian (17%) perspectives. Models typically assumed patients between 65–73 years old at moderate-risk of stroke initiated anticoagulation for/near a lifetime. All models reported cost/quality-adjusted life-year, 22% reported using a societal perspective, but none included indirect costs. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110 mg (n = 4)/150 mg (n = 2); rivaroxaban (n = 1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs vs. warfarin ranged from $3,547–$86,000 for dabigatran 150 mg, $20,713–$150,000 for dabigatran 110 mg, $4,084–$21,466 for sequentially-dosed dabigatran and $23,065–$57,470 for rivaroxaban. Apixaban was found economically-dominant to aspirin, and dominant or cost-effective ($11,400–$25,059) vs. warfarin. Indirect comparisons from 3 models suggested conflicting comparative cost-effectiveness results. Conclusions: Cost-effectiveness models frequently found newer anticoagulants cost-effective, but the lack of head-to-head trials and the heterogeneous characteristics of underlying trials and modeling methods make it difficult to determine the most cost-effective agent.

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  • Brendan L Limone & William L Baker & Jeffrey Kluger & Craig I Coleman, 2013. "Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Systematic Review of Cost-Effectiveness Models," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-15, April.
    • Handle: RePEc:plo:pone00:0062183
    DOI: 10.1371/journal.pone.0062183
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    References listed on IDEAS

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    1. Joyce H S You & Kia K N Tsui & Raymond S M Wong & Gergory Cheng, 2012. "Cost-Effectiveness of Dabigatran versus Genotype-Guided Management of Warfarin Therapy for Stroke Prevention in Patients with Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-9, June.
    2. Rita Faria & Eldon Spackman & Jane Burch & Belen Corbacho & Derick Todd & Chris Pepper & Nerys Woolacott & Stephen Palmer, 2013. "Dabigatran for the Prevention of Stroke and Systemic Embolism in Atrial Fibrillation: A NICE Single Technology Appraisal," PharmacoEconomics, Springer, vol. 31(7), pages 551-562, July.
    3. Soyon Lee & Rachel Mullin & Jon Blazawski & Craig I Coleman, 2012. "Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-9, October.
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    1. Kevin Bowrin & Jean-Baptiste Briere & Laurent Fauchier & Craig Coleman & Aurélie Millier & Mondher Toumi & Emilie Clay & Pierre Levy, 2020. "Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France," Post-Print hal-03655987, HAL.
    2. Yanzhi Song & Xiaodong Li & Settipalli Pavithra & Dong Li, 2013. "Idraparinux or Idrabiotaparinux for Long-Term Venous Thromboembolism Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-10, November.
    3. Kevin Bowrin & Jean-Baptiste Briere & Laurent Fauchier & Craig Coleman & Aurélie Millier & Mondher Toumi & Emilie Clay & Pierre Levy, 2020. "Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.

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