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Cost-Effectiveness Analysis of Direct-Acting Oral Anticoagulants for Stroke Prevention in Thai Patients with Non-Valvular Atrial Fibrillation and a High Risk of Bleeding

Author

Listed:
  • Thananan Rattanachotphanit

    (Mahasarakham University)

  • Chulaporn Limwattananon

    (Khon Kaen University)

  • Onanong Waleekhachonloet

    (Mahasarakham University)

  • Phumtham Limwattananon

    (Khon Kaen University)

  • Kittisak Sawanyawisuth

    (Khon Kaen University)

Abstract

Objective The objective of this study was to assess the cost effectiveness of direct-acting oral anticoagulants for stroke prevention in Thai patients with non-valvular atrial fibrillation and a HAS-BLED score of 3. Methods Total costs (US$) in 2017 and quality-adjusted life-years were estimated over 20 years using a Markov model. A base-case analysis was conducted under a societal perspective, which included direct healthcare, non-healthcare and indirect costs in Thailand. Clinical events for warfarin and utilities were obtained from Thai patients whenever possible. The efficacy of direct-acting oral anticoagulants was derived from trial-based East Asian subgroups and adjusted for time in the target international normalized ratio range of warfarin. Results In the base case, use of apixaban instead of warfarin incurred an additional cost of US$20,763 per quality-adjusted life-year gained. Substituting apixaban with rivaroxaban and rivaroxaban with high-dose edoxaban would incur an additional cost per quality-adjusted life-year by US$507 and US$434, respectively. Compared with warfarin, high-dose edoxaban had the lowest incremental cost-effectiveness ratio of US$9704/quality-adjusted life-year, followed by high-dose dabigatran (incremental cost-effectiveness ratio US$11,155/quality-adjusted life-year). The incremental cost-effectiveness ratios based on a payer perspective were similar. The incremental cost-effectiveness ratio was below Thailand’s cost-effectiveness threshold when high-dose dabigatran and edoxaban prices were reduced by 50%. Changes in key parameters had a minimal impact on incremental cost-effectiveness ratios. Conclusions For both societal and payer perspectives, high-dose edoxaban with a price below the country cost-effectiveness threshold should be the first anticoagulant option for Thai patients with non-valvular atrial fibrillation and a high risk of bleeding.

Suggested Citation

  • Thananan Rattanachotphanit & Chulaporn Limwattananon & Onanong Waleekhachonloet & Phumtham Limwattananon & Kittisak Sawanyawisuth, 2019. "Cost-Effectiveness Analysis of Direct-Acting Oral Anticoagulants for Stroke Prevention in Thai Patients with Non-Valvular Atrial Fibrillation and a High Risk of Bleeding," PharmacoEconomics, Springer, vol. 37(2), pages 279-289, February.
  • Handle: RePEc:spr:pharme:v:37:y:2019:i:2:d:10.1007_s40273-018-0741-3
    DOI: 10.1007/s40273-018-0741-3
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629, November.
    2. Riewpaiboon, Arthorn & Riewpaiboon, Wachara & Ponsoongnern, Kanyarat & Van den Berg, Bernard, 2009. "Economic valuation of informal care in Asia: A case study of care for disabled stroke survivors in Thailand," Social Science & Medicine, Elsevier, vol. 69(4), pages 648-653, August.
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    1. Siti Norain Azahar & Saperi Sulong & Wan Asyraf Wan Zaidi & Norliza Muhammad & Yusof Kamisah & Norliana Masbah, 2022. "Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(3), pages 1-17, January.

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