Abstract
ABSTRACT Background Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged.
Highlights
As part of the core reimbursement dossier, Health Technology Assessment bodies require both the clinical and economic evaluations of new technologies [1,2,3,4]
This paper aims to provide an illustration of a costeffectiveness model considering real-world evidence (RWE), using as an example an economic evaluation of oral anticoagula tion treatment for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF), in clinical practice in the UK
Patients treated with rivaroxaban experienced incre mental gains in both quality-adjusted life year (QALY) (0.12) and LYs (0.15) com pared with vitamin K antagonist (VKA): rivaroxaban was associated with fewer cases of MI (0.088 vs 0.096, i.e. a reduction of 8%), and a lower rate of strokes (0.228 vs 0.265, i.e. a reduction of 14%) and ICH bleeds (0.036 vs 0.042 i.e. a reduction of 15%), but was associated with a higher rate of GI bleeds (0.117 vs 0.088, i.e. an increase of 33%)
Summary
As part of the core reimbursement dossier, Health Technology Assessment bodies require both the clinical and economic evaluations of new technologies [1,2,3,4]. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable infor mation for decision-makers, in a context where RWE is more accessible and its value more acknowledged
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