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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.

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Related in: MedlinePlus

Cost-effectiveness acceptability curve
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Fig3: Cost-effectiveness acceptability curve

Mentions: Results from the one-way sensitivity analysis indicated that the relative risk of rivaroxaban vs. warfarin for stroke, the number of GP/monitoring visits, baseline intracranial bleed rate, and the treatment discontinuation rates were the main drivers of the cost-effectiveness analysis (Fig. 2). While, for example, the ICER was estimated at €5,193 per QALY gained should a patient on rivaroxaban no longer need to visit a physician, it would be around €19,659 per QALY if eight GP visits are required annually. Results from the PSA, based on 10,000 iterations, are presented in Fig. 3 and suggest that rivaroxaban is cost-effective compared with warfarin therapy in 66, 79, and 87 % of cases if a willingness-to-pay threshold of €10,000, €20,000 or €35,000 per additional QALY were to be considered, respectively.Fig. 2


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)

Cost-effectiveness acceptability curve
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Cost-effectiveness acceptability curve
Mentions: Results from the one-way sensitivity analysis indicated that the relative risk of rivaroxaban vs. warfarin for stroke, the number of GP/monitoring visits, baseline intracranial bleed rate, and the treatment discontinuation rates were the main drivers of the cost-effectiveness analysis (Fig. 2). While, for example, the ICER was estimated at €5,193 per QALY gained should a patient on rivaroxaban no longer need to visit a physician, it would be around €19,659 per QALY if eight GP visits are required annually. Results from the PSA, based on 10,000 iterations, are presented in Fig. 3 and suggest that rivaroxaban is cost-effective compared with warfarin therapy in 66, 79, and 87 % of cases if a willingness-to-pay threshold of €10,000, €20,000 or €35,000 per additional QALY were to be considered, respectively.Fig. 2

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