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Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France

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Listed:
  • Kevin Bowrin
  • Jean-Baptiste Briere
  • Laurent Fauchier
  • Craig Coleman
  • Aurélie Millier
  • Mondher Toumi
  • Emilie Clay
  • Pierre Levy

Abstract

Objective: The objective was to assess the real-world cost-effectiveness of rivaroxaban, versus vitamin K antagonists (VKAs), for stroke prevention in patients with atrial fibrillation (AF) from a French national health insurance perspective. Methods: A Markov model was developed with a lifetime horizon and cycle length of 3 months. All inputs were drawn from real-world evidence (RWE) studies: data on baseline patient characteristics at model entry were obtained from a French RWE study, clinical event rates as well as persistence rates for the VKA treatment arm were estimated from a variety of RWE studies, and a meta-analysis provided comparative effectiveness for rivaroxaban compared to VKA. Model outcomes included costs (drug costs, clinical event costs, and VKA monitoring costs), quality-adjusted life-years (QALY) and life-years (LY) gained, incremental cost per QALY, and incremental cost per LY. Sensitivity analyses were performed to test the robustness of the model and to better understand the results drivers. Results: In the base-case analysis, the incremental total cost was €714 and the total incremental QALYs and LYs were 0.12 and 0.16, respectively. The resulting incremental cost/QALY and incremental cost/LY were €6,006 and €4,586, respectively. The results were more sensitive to the inclusion of treatment-specific utility decrements and clinical event rates. Conclusions: Although there is no official willingness-to-pay threshold in France, these results suggest that rivaroxaban is likely to be cost-effective compared to VKA in French patients with AF from a national insurance perspective.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0225301
    DOI: 10.1371/journal.pone.0225301
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    References listed on IDEAS

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    1. 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.
    2. Craig I. Coleman & Jean-Baptiste Briere & Laurent Fauchier & Pierre Lévy & Kevin Bowrin & Mondher Toumi & Aurélie Millier & Vanessa Taieb & Olivia Wu, 2019. "Meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valvular atrial fibrillation," Post-Print hal-02273915, HAL.
    3. Hedwig Blommestein & Margreet Franken & Carin Uyl-de Groot, 2015. "A Practical Guide for Using Registry Data to Inform Decisions About the Cost Effectiveness of New Cancer Drugs: Lessons Learned from the PHAROS Registry," PharmacoEconomics, Springer, vol. 33(6), pages 551-560, June.
    4. Kevin Bowrin & Jean-Baptiste Briere & Pierre Lévy & Aurélie Millier & Emilie Clay & Mondher Toumi, 2019. "Cost-effectiveness analyses using real-world data: an overview of the literature," Post-Print hal-02292296, HAL.
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    1. Kevin Bowrin & Jean-Baptiste Briere & Pierre Lévy & Aurélie Millier & Jean Tardu & Mondher Toumi, 2020. "Real-world cost-effectiveness of rivaroxaban and apixaban vs VKA in stroke prevention in non-valvular atrial fibrillation in the UK," Post-Print hal-03120333, HAL.

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