PCV83 - Economic evaluation of apixaban for atrial fibrillation in costa Rica

Abstract

Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting approximately 40,000 to 80,000 inhabitants in Costa Rica. AF increases stroke, thrombo-embolism, deaths, heart failure and hospitalizations rates, affecting the quality of life and raising overall costs. Literature suggests anticoagulation is the best strategy to prevent strokes and reduce death rates in AF. The aim of this study was to assess the cost-effectiveness (CE) of warfarin against Apixaban, Rivaroxaban, and Dabigatran as therapy for AF, from the public health care perspective. A simulated cohort of patients with AF entered a decision-tree model to compare costs and effectiveness of Warfarin (5 mg/day) (comparator), Apixaban (5 mg/12 hours), Dabigatran (110 mg/12 hours and 150 mg/12 hours), and Rivaroxaban (20 mg/day). Effectiveness measures were: stroke, bleeding and myocardial infarction (MI) rates and deaths. The model used a lifetime horizon and only direct medical costs were considered (inpatient costs, medication expenses, adverse events costs, tests). Effectiveness and epidemiologic data were retrieved from published literature. Local costs (US$ 2012) were gathered from the Social Security of Costa Rica official databases. Apixaban resulted as the less expensive option for AF in adult patients and it was the only treatment that consistently prevented all three considered diseases: Three MIs, 18 strokes, 54 bleedings avoided when compared to Warfarin. Mortality rate was found to be similar with all strategies implemented. Overall costs were US$43,211,440.23 for warfarin, US$38,240,522.33 for Apixaban (lowest), US$38,458,665.03 for Dabigatran 110 mg, US$41,055,937.68 for Dabigatran 150 mg, and US$42,551,663.86 for Rivaroxaban. In the CE incremental analysis, Apixaban appeared as a cost-saving option. Apixaban obtained the highest probability of being cost-effective with a 3 GPB per capita in Costa Rica. PSA results support the robustness of these findings. Apixaban resulted as the cost-saving therapy for AF adult patients in Costa Rica.