PCV77 - Cost Effectiveness Of Apixaban, Dabigatran Rivaroxaban And Warfarin For Atrial Fibrillation In Guatemala

Abstract

Atrial Fibrillation (AF) affects 1–2% of the population, and this figure is likely to increase in the next 50 years. AF is associated with increased rates of death, stroke and other thromboembolic events, heart failure and hospitalizations, degraded quality of life and reduced exercise capacity. It is suggested that patients with AF should be stratified for the risk of stroke and bleedings and that most should receive antithrombotic therapy. The aim of this study was to assess the cost-effectiveness (CE) of Apixaban against other anticoagulation therapies for prevention on non-valvular atrial fibrillation (NVAF), from the private health care perspective. A simulated cohort of 1000 patients with NVAF entered a decision-tree model to compare costs and effectiveness of Warfarin (5 mg/24 hours), Apixaban (5 mg/12 hours), Dabigatran (110 mg/12 hours and 150 mg/12 hours), and Rivaroxaban (20 mg/24 hours). Effectiveness measures were: stroke, bleeding, myocardial infarction (MI) rates and deaths. Local costs were gathered from Guatemala’s official databases (US$, 2013) and only direct medical costs were considered. The model used a lifetime horizon with a 5% discount. Apixaban was the only treatment that consistently prevented all four considered diseases: 3 MIs, 4 strokes, 85 bleedings and 1 SE avoided when compared to Warfarin. Overall costs were US$33708.34 for warfarin, US$24538.68 for Apixaban, US$24757.57 for Dabigatran 110 mg, US$24198.23 for Dabigatran 150 mg, and US$24252.46 for Rivaroxaban. In terms of QALY’s, Apixaban earned the highest amount with 5.740, followed by Rivaroxaban, Dabigatran 150 mg, Dabigatran 110 mg and Warfarin. In the CE incremental analysis, Apixaban was a cost-effective option. Apixaban obtained the highest probability of being cost-effective (45%) with a 3 GPB per capita in Guatemala. Apixaban is a Cost-Effective option for the Guatemala’s Private Health System.