PCV42 - A PHARMACOECONOMIC ANALYSIS OF THE USE OF APIXABAN FOR THE PREVENTION OF STROKE AND SYSTEMIC EMBOLISM IN RUSSIAN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Abstract

To compare the costs of apixaban and competing novel oral anticoagulant agents (NOACs) for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation, and to define the advisability of its inclusion into the Program of state guarantees (PSG). A model of the budget impact of the use of apixaban compared to other NOACs was based on the data of a meta-analysis by JA López-López et al. (2017). Three scenarios of therapy were considered: apixaban 5 mg/bid, dabigatran etexilate 150 mg/bid, and rivaroxaban 20 mg/uid. According to the clinical data, the efficacy of the considered drugs was similar. The three-year cost for the state budget was compared for different ratios of drug purchases if apixaban was included in the PSG program. The average cost of one-year therapy with NOACs was 29,843.58 RUB per patient in case of apixaban, which was lower than in case of dabigatran etexilate (46,979.44 RUB) and rivaroxaban (42,678.88 RUB). The inclusion of apixaban into the PEM program reduces the expected cost for the health care system up to 20% in the three-year horizon of study. The savings on the prevention of embolic complications of atrial fibrillation per a nominal group of 100 persons is 1,656,283.13 RUB in case of the introduced medical technology compared with 1,177,846.50 RUB for dabigatran etexilate and 1,177,846.50 RUB for rivaroxaban. The sensitivity analysis showed that the results of modeling are robust to changes of the input parameters. The use of apixaban is the most rational strategy to reduce of burden of additional costs of NOACs for the prevention of stroke and systemic embolism in Russian patients with non-valvular atrial fibrillation, who receive medical care in the framework of the Program of state guarantees.