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Cost-effectiveness of anticoagulation in patients with nonvalvular atrial fibrillation with edoxaban compared to warfarin in Germany.

Krejczy M, Harenberg J, Wehling M, Obermann K, Lip GY - Biomed Res Int (2015)

Bottom Line: The incremental cost-effectiveness ratio was 50.000 and 68.000 euro per quality-adjusted life years for the higher and lower dose of edoxaban (Monte Carlo simulation).These findings were also similar to those for apixaban and more cost-effective than the other NOAC regimens.The willingness-to-pay threshold was lowest for 60 mg edoxaban compared to all direct oral anticoagulants and for 30 mg edoxaban compared to dabigatran and rivaroxaban.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstraße 14, 68169 Mannheim, Germany.

ABSTRACT
We compared the cost-utility analysis for edoxaban at both doses with that of dabigatran at both doses, rivaroxaban, and apixaban (non vitamin K antagonist oral anticoagulants, NOAC) in a German population. Data of clinical outcome events were taken from edoxaban's ENGAGE-AF, dabigatran's RE-LY, rivaroxaban's ROCKET, and apixaban's ARISTOTLE trials. The base-case analyses of a 65-year-old person with a CHADS2 score >1 gained 0.17 and 0.21 quality-adjusted life years over warfarin for 30 mg od and 60 mg od edoxaban, respectively. The incremental cost-effectiveness ratio was 50.000 and 68.000 euro per quality-adjusted life years for the higher and lower dose of edoxaban (Monte Carlo simulation). These findings were also similar to those for apixaban and more cost-effective than the other NOAC regimens. The current market costs for direct oral anticoagulants are high in relation to the quality of life gained from a German public health care insurance perspective. The willingness-to-pay threshold was lowest for 60 mg edoxaban compared to all direct oral anticoagulants and for 30 mg edoxaban compared to dabigatran and rivaroxaban.

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Related in: MedlinePlus

Outline of the Markov model for data of the ENGAGE-AF study. Here one dose of edoxaban is given as an example used in the Markov model. ICH intracerebral haemorrhage; TIA transient ischemic attack (modified from [5]).
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fig1: Outline of the Markov model for data of the ENGAGE-AF study. Here one dose of edoxaban is given as an example used in the Markov model. ICH intracerebral haemorrhage; TIA transient ischemic attack (modified from [5]).

Mentions: We used the Markov decision model to analyse the QALYs, total costs (one-time costs for events, rehabilitation costs for inpatient and ambulatory care, inpatient medical treatment costs, and daily costs for drugs), and ICER based on the data of the ENGAGE-AF [1] study. The results were compared with our data previously derived from the RE-LY, ROCKET-AF, and ARISTOTLE trials [5] under a German health care insurance perspective. The following health states and outcome events were included: healthy with NVAF, transient ischemic attack, ischemic stroke (fatal, moderate to severe, and mild), haemorrhage (fatal, moderate to severe intracranial, mild intracranial, major noncerebral, and minor noncerebral), myocardial infarction (MI), recurrent and combined events, and cardiovascular mortality using the results from the ENGAGE-AF trial and costs for the German population [8] (Figure 1). Definitions of these events were taken from the ENGAGE-AF study [1]. Event probabilities were not included if they were not reported consistently across the studies (systemic embolism, pulmonary embolism, hemorrhagic stroke, and bleeding in other locations) (Table 1).


Cost-effectiveness of anticoagulation in patients with nonvalvular atrial fibrillation with edoxaban compared to warfarin in Germany.

Krejczy M, Harenberg J, Wehling M, Obermann K, Lip GY - Biomed Res Int (2015)

Outline of the Markov model for data of the ENGAGE-AF study. Here one dose of edoxaban is given as an example used in the Markov model. ICH intracerebral haemorrhage; TIA transient ischemic attack (modified from [5]).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4380099&req=5

fig1: Outline of the Markov model for data of the ENGAGE-AF study. Here one dose of edoxaban is given as an example used in the Markov model. ICH intracerebral haemorrhage; TIA transient ischemic attack (modified from [5]).
Mentions: We used the Markov decision model to analyse the QALYs, total costs (one-time costs for events, rehabilitation costs for inpatient and ambulatory care, inpatient medical treatment costs, and daily costs for drugs), and ICER based on the data of the ENGAGE-AF [1] study. The results were compared with our data previously derived from the RE-LY, ROCKET-AF, and ARISTOTLE trials [5] under a German health care insurance perspective. The following health states and outcome events were included: healthy with NVAF, transient ischemic attack, ischemic stroke (fatal, moderate to severe, and mild), haemorrhage (fatal, moderate to severe intracranial, mild intracranial, major noncerebral, and minor noncerebral), myocardial infarction (MI), recurrent and combined events, and cardiovascular mortality using the results from the ENGAGE-AF trial and costs for the German population [8] (Figure 1). Definitions of these events were taken from the ENGAGE-AF study [1]. Event probabilities were not included if they were not reported consistently across the studies (systemic embolism, pulmonary embolism, hemorrhagic stroke, and bleeding in other locations) (Table 1).

Bottom Line: The incremental cost-effectiveness ratio was 50.000 and 68.000 euro per quality-adjusted life years for the higher and lower dose of edoxaban (Monte Carlo simulation).These findings were also similar to those for apixaban and more cost-effective than the other NOAC regimens.The willingness-to-pay threshold was lowest for 60 mg edoxaban compared to all direct oral anticoagulants and for 30 mg edoxaban compared to dabigatran and rivaroxaban.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstraße 14, 68169 Mannheim, Germany.

ABSTRACT
We compared the cost-utility analysis for edoxaban at both doses with that of dabigatran at both doses, rivaroxaban, and apixaban (non vitamin K antagonist oral anticoagulants, NOAC) in a German population. Data of clinical outcome events were taken from edoxaban's ENGAGE-AF, dabigatran's RE-LY, rivaroxaban's ROCKET, and apixaban's ARISTOTLE trials. The base-case analyses of a 65-year-old person with a CHADS2 score >1 gained 0.17 and 0.21 quality-adjusted life years over warfarin for 30 mg od and 60 mg od edoxaban, respectively. The incremental cost-effectiveness ratio was 50.000 and 68.000 euro per quality-adjusted life years for the higher and lower dose of edoxaban (Monte Carlo simulation). These findings were also similar to those for apixaban and more cost-effective than the other NOAC regimens. The current market costs for direct oral anticoagulants are high in relation to the quality of life gained from a German public health care insurance perspective. The willingness-to-pay threshold was lowest for 60 mg edoxaban compared to all direct oral anticoagulants and for 30 mg edoxaban compared to dabigatran and rivaroxaban.

Show MeSH
Related in: MedlinePlus