Cost-effectiveness analysis of first-line NOAC prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation
Abstract
Introduction: Atrial fibrillation (AF) is a cardiac rhythm disorder with a prevalence of 3.37% of the population, 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 effi cacy 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.
Conclusion: NOAC, compared to the current standard of treatment - warfarin, provides more benefits in terms of overall survival, improved quality of life and prevention of cardiovascular events, while meeting the cost-effective assumption of ICERs far below the willingness to pay 1.2 mils CZK.