RT Journal Article
T1 Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain.
A1 Escobar Cervantes, Carlos
A1 Martí-Almor, Julio
A1 Cabeza, Alejandro Isidoro Pérez
A1 Bowrin, Kevin
A1 Llorac Moix, Aleix
A1 Genís Gironès, Mar
A1 Gasche, David
A1 Millier, Aurélie
A1 Tardu, Jean
A1 Toumi, Mondher
A1 Briere, Jean-Baptiste
AB A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.
YR 2022
FD 2022-04-20
LK http://hdl.handle.net/10668/20425
UL http://hdl.handle.net/10668/20425
LA en
DS RISalud
RD Apr 19, 2025