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Economic Evaluation of Apixaban for the Prevention of Stroke in Non-Valvular Atrial Fibrillation in the Netherlands

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  • Jelena Stevanović
  • Marjolein Pompen
  • Hoa H Le
  • Mark H Rozenbaum
  • Robert G Tieleman
  • Maarten J Postma

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.

Suggested Citation

  • Jelena Stevanović & Marjolein Pompen & Hoa H Le & Mark H Rozenbaum & Robert G Tieleman & Maarten J Postma, 2014. "Economic Evaluation of Apixaban for the Prevention of Stroke in Non-Valvular Atrial Fibrillation in the Netherlands," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-11, August.
  • Handle: RePEc:plo:pone00:0103974
    DOI: 10.1371/journal.pone.0103974
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    References listed on IDEAS

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    1. Bo Hu & Alex Z. Fu, 2010. "Predicting Utility for Joint Health States: A General Framework and a New Nonparametric Estimator," Medical Decision Making, , vol. 30(5), pages 29-39, September.
    2. 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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    Cited by:

    1. Xue Li & Vicki C Tse & Wallis C Y Lau & Bernard M Y Cheung & Gregory Y H Lip & Ian C K Wong & Esther W Chan, 2016. "Cost-Effectiveness of Apixaban versus Warfarin in Chinese Patients with Non-Valvular Atrial Fibrillation: A Real-Life and Modelling Analyses," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    2. Alexander V van Schoonhoven & Judith J Gout-Zwart & Marijke J S de Vries & Antoinette D I van Asselt & Evgeni Dvortsin & Pepijn Vemer & Job F M van Boven & Maarten J Postma, 2019. "Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-22, September.
    3. Lisa A de Jong & Jessie Groeneveld & Jelena Stevanovic & Harrie Rila & Robert G Tieleman & Menno V Huisman & Maarten J Postma & Marinus van Hulst, 2019. "Cost-effectiveness of apixaban compared to other anticoagulants in patients with atrial fibrillation in the real-world and trial settings," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-17, September.

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    1. Xue Li & Vicki C Tse & Wallis C Y Lau & Bernard M Y Cheung & Gregory Y H Lip & Ian C K Wong & Esther W Chan, 2016. "Cost-Effectiveness of Apixaban versus Warfarin in Chinese Patients with Non-Valvular Atrial Fibrillation: A Real-Life and Modelling Analyses," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
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