Περίληψη:
Background Strokes attributed to atrial fibrillation (AF) represent a
major cause of adult disability and a great burden to society and
healthcare systems.
Objectives Our objective was to assess the cost effectiveness of
apixaban, a direct acting oral anticoagulant (DOAC), versus warfarin or
aspirin for patients with AF in the Greek healthcare setting.
Methods We used a previously published Markov model to simulate clinical
events for patients with AF treated with apixaban, the vitamin K
antagonist (VKA) warfarin, or aspirin. Clinical events (ischemic and
hemorrhagic stroke, intracranial hemorrhage, other major bleed,
clinically relevant non-major bleed, myocardial infarction, and
cardiovascular [CV] hospitalizations) were modeled using efficacy data
from the ARISTOTLE and AVERROES clinical trials. The cohort’s baseline
characteristics also sourced from these trials. Among VKA-suitable
patients, 64.7% were men with a mean age of 70 years and average
CHADS(2) (cardiac failure, hypertension, age, diabetes, stroke(2)) score
of 2.1, whereas 58.5% of VKA-unsuitable patients were men with a mean
age of 70 years and a CHADS(2) score of 2.0. A panel of experts
(cardiologists and internists) provided information on the resource use
associated with the management of AF. Cost calculations reflect the
local clinical setting and a third-party payer perspective (epsilon,
discounted at 3%).
Results Based on a simulation of 1000 VKA-suitable patients over a
lifetime horizon, the use of apixaban versus warfarin resulted in 26
fewer strokes and systemic embolisms in total, 65 fewer bleeds, 41 fewer
myocardial infarctions, and 29 fewer CV-related deaths, with an
incremental cost-effectiveness ratio (ICER) of epsilon
14,478/quality-adjusted life-year (QALY). For VKA-unsuitable patients,
apixaban versus aspirin resulted in 72 fewer strokes and systemic
embolisms and 57 fewer CV-related deaths, with an ICER of
(sic)7104/QALY. Sensitivity analyses indicated that results were robust.
Conclusions Based on the present analysis, apixaban represents a
cost-effective treatment option versus warfarin and aspirin for the
prevention of stroke in patients with AF from a Greek healthcare payer
perspective over a lifetime horizon.
Συγγραφείς:
Athanasakis, Kostas
Boubouchairopoulou, Nadia
Karampli,
Eleftheria
Tarantilis, Filippos
Savvari, Paraskevi
Bilitou,
Aikaterini
Kyriopoulos, John
