Abstract | BACKGROUND: METHODS: Based on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE) trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS(2) score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs), life years saved and incremental cost-effectiveness ratios. RESULTS: Under base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY. CONCLUSIONS: In patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin.
|
Authors | Soyon Lee, Rachel Mullin, Jon Blazawski, Craig I Coleman |
Journal | PloS one
(PLoS One)
Vol. 7
Issue 10
Pg. e47473
( 2012)
ISSN: 1932-6203 [Electronic] United States |
PMID | 23056642
(Publication Type: Journal Article)
|
Chemical References |
- Anticoagulants
- Pyrazoles
- Pyridones
- apixaban
- Warfarin
|
Topics |
- Anticoagulants
(economics, therapeutic use)
- Atrial Fibrillation
(drug therapy)
- Cost-Benefit Analysis
- Female
- Humans
- Male
- Markov Chains
- Pyrazoles
(economics, therapeutic use)
- Pyridones
(economics, therapeutic use)
- Stroke
(prevention & control)
- Warfarin
(economics, therapeutic use)
|