Cost-effectiveness analysis of apixaban versus dabigatran for prevention of stroke in patients with non-valvular atrial fibrillation in spain

• Autores: L. Betegón Nicolás, C. Canal Fontcuberta, G. Escobar Alabaldejo, Marina de Salas Cansado, D. Rubio-Rodriguez
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 16, Nº. 5, 2014, págs. 3-3
• Idioma: inglés
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• Resumen

  • Objective: To assess the cost-effectiveness of apixaban vs. dabigatran in stroke prevention in patients with non-valvular atrial fibrillation (NVAF) in Spain.

    Method: A Markov model was developed, with cycles of six weeks, throughout the patient’s life and 10 health states. The analysis was done from the Spanish National Health System (SNS) and societal perspective. The safety and efficacy of the drugs were obtained from a meta-analysis of pairwise indirect comparisons. Drug costs (apixaban 10 mg/day [5 mg bid]; dabigatran: 220 [110 mg bid] or 300 [150 mg bid] mg/day), NVAF complications and disease management costs were obtained from Spanish sources. An annual discount rate of 3.5% for costs and health outcomes was applied.

    Results: In a cohort of 1,000 patients with NVAF during their lifetime, apixaban were projected to avoid numerous complications versus dabigatran (24 ischemic strokes and 28 related deaths vs. dabigatran 110 mg bid; 11 ischemic strokes, 29 bleedings and 19 deaths vs. dabigatran 150 mg bid). Consequently, each patient treated with apixaban could obtain more years of life (0.126 and 0.084 LYG, respectively) and more quality-adjusted life-years (0.107 and 0.071 QALY, respectively).

    Apixaban generated higher overall costs per patient vs. dabigatran 110 mg bid from the SNS perspective (€139) but savings would arise from the societal perspective (–€524), with a cost per LYG and QALY gained of €1,103 and €1,299 for the SNS, and apixaban being dominant (more effective with less cost than dabigatran 110 mg bid) for the Society. The cost per QALY gained, from the SNS and societal perspective, compared with dabigatran 150 mg bid would be €6,591 and €10,676, respectively. Deterministic and probabilistic sensitivity analyses confirmed the stability of these results.

    Conclusion: According to the model outcomes, apixaban would be cost-effective versus dabigatran for the prevention of stroke in patients with NVAF in Spain