Cor Vasa 2019, 61(4):e354-e369 | DOI: 10.33678/cor.2019.058

(Cost-effectiveness analysis of first-line NOAC prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation)

Miloš Táborskýa, Aleš Tomekb, Robert Čihákc, Ondřej Škodad, Josef Daněke, Martin Kolekf
a I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc
b Neurologická klinika, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
c Klinika kardiologie, Institut klinické a experimentální medicíny, Praha
d Neurologické oddělení, Nemocnice Jihlava, Jihlava
e Kardiologické oddělení, Interní klinika, 1. lékařská fakulta Univerzity Karlovy a Ústřední vojenská nemocnice, Praha
f OAKS consulting s.r.o, Praha

Introduction: Atrial fibrillation (AF) is a cardiac rhythm disorder with a prevalence of 3.37% of the popula- tion, which increases with age.1 AF patients have a high risk of stroke and systemic embolism, which continues to increase when the patient has undergone transient ischemic attack (TIA) or stroke.

Objective: The aim of the pharmacoeconomic evaluation is to compare the cost and benefit of NOAC (novel oral anticoagulants) treatment against warfarin treatment as a first-line prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.

Methods: The Markov model evaluates the cost-effectiveness of prevention from the perspective of a health care payer with the result of incremental cost-effectiveness ratio (ICER) per Quality Adjusted Life Year (QALY) and Life-Year Gained (LYG). The patient population is based on available clinical evidence, especially ARISTOTLE, RE-LY, ROCKET-AF, ENGAGE AF-TIMI.2-6, Results: According to the results, NOAC achieve higher efficacy and safety while maintaining cost effectiveness compared to warfarin. ICER for apixaban vs. warfarin is 479,014 CZK / QALY with 0.184 QALY and 0.177 LYG; dabigatran 150 mg vs. warfarin CZK 582,768 with a profit of 0.121 QALY and 0.099 LYG; edoxaban 60 mg vs. warfarin CZK 563,057 with 0.149 QALY and 0.129 LYG and finally rivaroxaban vs. warfarin 664,238 CZK with 0.126 QALY and 0.102 LYG. Methodological and probabilistic sensitivity analysis were performed and confirmed the added value of NOAC treatment compared to existing therapy.

Keywords: Apixaban, CUA, Dabigatran, Edoxaban, Non-valvular atrial fi brillation, Rivaroxaban, Stroke prevention, Systemic embolism, Warfarin

Received: July 8, 2019; Accepted: July 16, 2019; Published: August 11, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Táborský M, Tomek A, Čihák R, Škoda O, Daněk J, Kolek M. (Cost-effectiveness analysis of first-line NOAC prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation). Cor Vasa. 2019;61(4):e354-369. doi: 10.33678/cor.2019.058.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. VZP, Analýza dat VZP o prevalenci indikace I48. 2017.
    2. Connolly SJ, Ezekowitz MD, Yusuf S, et al.; Randomized Evaluation of Long-Term Anticoagulation Therapy Investigators. Newly identified events in the RE-LY trial. N Engl J Med 2010;363:1875-1876. Go to original source... Go to PubMed...
    3. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-1151. Go to original source... Go to PubMed...
    4. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093-2104. Go to original source... Go to PubMed...
    5. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981-992. Go to original source... Go to PubMed...
    6. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883-891. Go to original source... Go to PubMed...
    7. Ticháček M, Drábková J. Náhlé cévní mozkové příhody. Dostupné z: https://www.urgmed.cz/postupy/cmp.htm. [Viděno: 15. 3. 2018].
    8. Bruthans J. Epidemiologie cévních mozkových příhod. Kap Kardiol 2010;2:122-132.
    9. FNUSA, 2011. Dostupné z: http://www.fnusa.cz/files/mrtvice.pdf. [Viděno: 12. 3. 2018].
    10. Neumann J, Škoda O. Sekundární prevence ischemických cévních mozkových příhod - přehled současných možností. Medicína Praxi 2007;4:233-236.
    11. Čihák R, Haman L, Táborský M. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Summary of the document prepared by the Czech Society of Cardiology. Cor Vasa 2016;58:e636-e683. Go to original source...
    12. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45:2160-2236. Go to original source... Go to PubMed...
    13. Čihák R, Heinc P, Haman L, et al. Fibrilace síní - doporučený diagnostický a léčebný postup České kardiologické společnosti. Cor Vasa 2011;53(Suppl.):27-52. Go to original source...
    14. Lip GY, Mitchell SA, Liu X, et al. Relative efficacy and safety of non-Vitamin K oral anticoagulants for non-valvular atrial fibrillation: Network meta-analysis comparing apixaban, dabigatran, rivaroxaban and edoxaban in three patient subgroups. Int J Cardiol 2016;204:88-94. Go to original source... Go to PubMed...
    15. SÚKL, Seznam cen a úhrad LP/PZLÚ k 1. 6. 2018. 2018.
    16. ČESKO, Vyhláška č. 348/2016 Sb. o stanovení hodnot bodu, výše úhrad hrazených služeb a regulačních omezení pro rok 2017. 2016.
    17. Seznam výkonů, Seznam zdravotních výkonů s bodovými hodnotami. EZ Centrum, 2017.
    18. DRG 2018
    19. Lanitis T, Kongnakorn T. Analýza nákladové efektivity přípravku apixaban v prevenci tromboembolických příhod u pacientů s atriální fibrilací. 2013.
    20. Easton JD, Lopes RD, Bahit MC, et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of the ARISTOTLE trial. Lancet Neurol 2012;11:503-511. Go to original source... Go to PubMed...
    21. ČSÚ, Úmrtnostní tabulky | ČSÚ, 2014. Dostupné z: https://www.czso.cz/csu/czso/umrtnostni_tabulky. [Viděno: 15-bře-2018].
    22. Friberg L, Hammar N, Pettersson H, Rosenqvist M. Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF). Eur Heart J 2007;28:2346-2353. Go to original source... Go to PubMed...
    23. Brønnum-Hansen H, Davidsen M, Thorvaldsen P. Long-term survival and causes of death after stroke. Stroke 2001;32:2131-2136. Go to original source... Go to PubMed...
    24. Henriksson KM, Farahmand B, Johansson S, et al. Survival after stroke - the impact of CHADS2 score and atrial fibrillation. Int J Cardiol 2010;141:18-23. Go to original source... Go to PubMed...
    25. Huybrechts KF, Caro JJ, Xenakis JJ, Vemmos KN. The prognostic value of the modified Rankin Scale score for long-term survival after first-ever stroke. Results from the Athens Stroke Registry. Cerebrovasc Dis Basel Switz 2008;26:381-387. Go to original source... Go to PubMed...
    26. Freeman JV, Zhu RP, Owens DK, et al., Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med 2011;154:1-11. Go to original source... Go to PubMed...
    27. Gage BF, Cardinalli AB, Owens DK. The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med 1996;156:1829-1836. Go to original source...
    28. Sullivan PW, Slejko JF, Sculpher MJ, Ghushchyan V. Catalogue of EQ-5D scores for the United Kingdom. Med Decis Making 2011;31:800-804. Go to original source... Go to PubMed...
    29. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk Factors for Intracerebral Hemorrhage in the General Population: A Systematic Review. Stroke 2003;34:2060-2065. Go to original source... Go to PubMed...
    30. SÚKL, SP-CAU-028 - Postup pro posuzování analýzy nákladové efektivity. SÚKL, 17. 5. 2017.
    31. Prezentace k semináři 9 - Sekce cenové a úhradové regulace, Státní ústav pro kontrolu léčiv. Dostupné z: http://www.sukl.cz/sukl/dalsi-informace/prezentace-k-seminari-9-sekce-cenove-a-uhradove-regulace. [Viděno: 28-bře-2018].
    32. Shah A, Shewale A, Hayes CJ, Martin BC. Cost-Effectiveness of Oral Anticoagulants for Ischemic Stroke Prophylaxis Among Nonvalvular Atrial Fibrillation Patients. Stroke 2016;47:1555-1561. Go to original source... Go to PubMed...
    33. http://www.cmp.cz/jnp/cz/pece_o_cmp_v_cr/index.html
    34. IKTA.CZ, IKTA.CZ: Úvod. Dostupné z: http://www.ikta.cz/. [Viděno: 15. 3. 2018].
    35. Škoda O, Herzig R, Mikulík R, et al. Klinický standard pro diagnostiku a léčbu pacientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou. Čes Slov Neurol Neurochir 2016;79/112:351-363. Go to original source...

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content


    Cor et Vasa

    You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

    I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.


    No
    Yes