Limits...
Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting.

Kleintjens J, Li X, Simoens S, Thijs V, Goethals M, Rietzschel ER, Asukai Y, Saka Ö, Evers T, Faes P, Vansieleghem S, De Ruyck M - Pharmacoeconomics (2013)

Bottom Line: This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained.These results are based on valuated data from 2010.Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.

View Article: PubMed Central - PubMed

Affiliation: Deloitte Health Economics and Outcomes Research Group, Brussels, Belgium.

ABSTRACT

Background: Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines.

Objective: The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk.

Methods: A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature.

Results: Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.

Conclusions: The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.

Show MeSH

Related in: MedlinePlus

Structure of the model. Afib atrial fibrillation, IC intracranial, MI myocardial infarction, Tx treatment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3824571&req=5

Fig1: Structure of the model. Afib atrial fibrillation, IC intracranial, MI myocardial infarction, Tx treatment

Mentions: For this study, a Markov cost-effectiveness model was designed that can be used by decision makers to systematically assess the comparative costs and outcomes of a new treatment compared with warfarin (Fig. 1). Patients with a mean age of 73 years and suffering from non-valvular AF at moderate (CHADS2 score = 2) to high risk of stroke (CHADS2 score = 3 or higher) enter the model and receive chronic treatment with either rivaroxaban (new treatment, 15–20 mg oral tablet, once daily) or dose-adjusted warfarin (comparator treatment, target INR of 2.5). In both cases, patients received aspirin after discontinuation of the initial treatment. The evaluation was carried out from the perspective of the Belgian health care payer (i.e. National Institute for Health and Disability Insurance and patients).Fig. 1


Cost-effectiveness of rivaroxaban versus warfarin for stroke prevention in atrial fibrillation in the Belgian healthcare setting.

Kleintjens J, Li X, Simoens S, Thijs V, Goethals M, Rietzschel ER, Asukai Y, Saka Ö, Evers T, Faes P, Vansieleghem S, De Ruyck M - Pharmacoeconomics (2013)

Structure of the model. Afib atrial fibrillation, IC intracranial, MI myocardial infarction, Tx treatment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824571&req=5

Fig1: Structure of the model. Afib atrial fibrillation, IC intracranial, MI myocardial infarction, Tx treatment
Mentions: For this study, a Markov cost-effectiveness model was designed that can be used by decision makers to systematically assess the comparative costs and outcomes of a new treatment compared with warfarin (Fig. 1). Patients with a mean age of 73 years and suffering from non-valvular AF at moderate (CHADS2 score = 2) to high risk of stroke (CHADS2 score = 3 or higher) enter the model and receive chronic treatment with either rivaroxaban (new treatment, 15–20 mg oral tablet, once daily) or dose-adjusted warfarin (comparator treatment, target INR of 2.5). In both cases, patients received aspirin after discontinuation of the initial treatment. The evaluation was carried out from the perspective of the Belgian health care payer (i.e. National Institute for Health and Disability Insurance and patients).Fig. 1

Bottom Line: This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained.These results are based on valuated data from 2010.Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.

View Article: PubMed Central - PubMed

Affiliation: Deloitte Health Economics and Outcomes Research Group, Brussels, Belgium.

ABSTRACT

Background: Warfarin, an inexpensive drug that has been available for over half a century, has been the mainstay of anticoagulant therapy for stroke prevention in patients with atrial fibrillation (AF). Recently, rivaroxaban, a novel oral anticoagulant (NOAC) which offers some distinct advantages over warfarin, the standard of care in a world without NOACs, has been introduced and is now recommended by international guidelines.

Objective: The aim of this study was to evaluate, from a Belgian healthcare payer perspective, the cost-effectiveness of rivaroxaban versus use of warfarin for the treatment of patients with non-valvular AF at moderate to high risk.

Methods: A Markov model was designed and populated with local cost estimates, safety-on-treatment clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature.

Results: Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.308 vs. 0.321 events), intracranial bleeds (0.048 vs. 0.063), and myocardial infarctions (0.082 vs. 0.095) per patient compared with warfarin. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.042 life-threatening events per patient, and increases of 0.111 life-years and 0.094 quality-adjusted life-years (QALYs) versus warfarin treatment. This resulted in an incremental cost-effectiveness ratio of €8,809 per QALY or €7,493 per life-year gained. These results are based on valuated data from 2010. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with warfarin in 87 % of cases should a willingness-to-pay threshold of €35,000/QALY gained be considered.

Conclusions: The present analysis suggests that rivaroxaban is a cost-effective alternative to warfarin therapy for the prevention of stroke in patients with AF in the Belgian healthcare setting.

Show MeSH
Related in: MedlinePlus