![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Objectives:
To conduct an economic evaluation of the currently prescribed treatments for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) including warfarin, aspirin, and novel oral anticoagulants (NOACs) from a French payer perspective.
Methods:
A previously published Markov model was adapted in accordance to the new French guidelines of the Commission for Economic Evaluation and Public Health (CEESP), to adopt the recommended efficiency frontier approach. A cohort of patients with NVAF eligible for stroke preventive treatment was simulated over lifetime. Clinical events modeled included strokes, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds, and myocardial infarction. Efficacy and bleeding data for warfarin, apixaban, and aspirin were obtained from ARISTOTLE and AVERROES trials, whilst efficacy data for other NOACs were from published indirect comparisons. Acute medical costs were obtained from a dedicated analysis of the French national hospitalization database (PMSI). Long-term medical costs and utility data were derived from the literature. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model projections.
Results:
Warfarin and apixaban were the two optimal treatment choices, as the other five treatment strategies including aspirin, dabigatran 110 mg, dabigatran in sequential dosages, dabigatran 150 mg, and rivaroxaban were strictly dominated on the efficiency frontier. Further, apixaban was a cost-effective alternative vs warfarin with an incremental cost of €2314 and an incremental quality-adjusted life year (QALY) of 0.189, corresponding to an incremental cost-effectiveness ratio (ICER) of €12,227/QALY.
Conclusions:
Apixaban may be the most economically efficient alternative to warfarin in NVAF patients eligible for stroke prevention in France. All other strategies were dominated, yielding apixaban as a less costly yet more effective treatment alternative. As formally requested by the CEESP, these results need to be verified in a French clinical setting using stroke reduction and bleeding safety observed in real-life patient cohorts using these anticoagulants.
Transparency
Declaration of funding
This work was supported by a grant from Pfizer and Bristol-Myers Squibb.
Declaration of financial/other relationships
Pfizer and Bristol-Myers Squibb (BMS) manufacture apixaban. TL and TK are employees of Evidera and were paid consultants to Pfizer and BMS in connection with this study. FEC and AFG are employees of BMS France. IK is an employee of Pfizer France. IDZ is an employee of the Mondor Hospital (Créteil, France) and URC Eco and was a paid consultant to Pfizer and BMS in connection with this study. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.
Notice of Correction
The version of this article published online ahead of print on 29 May 2014 contained some errors in the affiliation details and references. Authors F. E. Cotté and A. F. Gaudin should have been affiliated with “Bristol-Myers Squibb, Health Economics & Outcomes Research, Rueil-Malmaison, France” and author I. Kachanar should have been affiliatied with “Pfizer, Health Economics & Outcomes Research, Paris, France”.
Also, references 25, 27, 28 and 30 were replaced and the original reference 39, “Clinical Study Report from Sponsor. A phase 3, randomized, double-blind, placebo-controlled, multi-center study confirming the efficacy and safety of Genz-112638 in patients with Gaucher Disease Type 1 (ENGAGE); 2013:GZGD02507”, was deleted and as a result subsequent references and in-text citations were updated to reflect this change. The errors have been corrected for this version.