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Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain

Author

Listed:
  • Carlos Escobar Cervantes
  • Julio Martí-Almor
  • Alejandro Isidoro Pérez Cabeza
  • Kevin Bowrin
  • Aleix Llorac Moix
  • Mar Genís Gironès
  • David Gasche
  • Aurélie Millier
  • Jean Tardu
  • Mondher Toumi
  • Jean-Baptiste Briere

Abstract

Aims: 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. Methods: 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. Results: 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. Conclusion: 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.

Suggested Citation

  • Carlos Escobar Cervantes & Julio Martí-Almor & Alejandro Isidoro Pérez Cabeza & Kevin Bowrin & Aleix Llorac Moix & Mar Genís Gironès & David Gasche & Aurélie Millier & Jean Tardu & Mondher Toumi & Jea, 2022. "Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain," PLOS ONE, Public Library of Science, vol. 17(4), pages 1-18, April.
    • Handle: RePEc:plo:pone00:0266658
    DOI: 10.1371/journal.pone.0266658
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    References listed on IDEAS

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    1. Andrej Janzic & Mitja Kos, 2015. "Cost Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Depending on the Quality of Warfarin Anticoagulation Control," PharmacoEconomics, Springer, vol. 33(4), pages 395-408, April.
    2. Kevin Bowrin & Jean-Baptiste Briere & Laurent Fauchier & Craig Coleman & Aurélie Millier & Mondher Toumi & Emilie Clay & Pierre Levy, 2020. "Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    3. Kevin Bowrin & Jean-Baptiste Briere & Laurent Fauchier & Craig Coleman & Aurélie Millier & Mondher Toumi & Emilie Clay & Pierre Levy, 2020. "Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France," Post-Print hal-03655987, HAL.
    4. Hedwig Blommestein & Margreet Franken & Carin Uyl-de Groot, 2015. "A Practical Guide for Using Registry Data to Inform Decisions About the Cost Effectiveness of New Cancer Drugs: Lessons Learned from the PHAROS Registry," PharmacoEconomics, Springer, vol. 33(6), pages 551-560, June.
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