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Meta-Analysis
. 2022 Apr 20;17(4):e0266658.
doi: 10.1371/journal.pone.0266658. eCollection 2022.

Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain

Carlos Escobar Cervantes  1 , Julio Martí-Almor  2 , Alejandro Isidoro Pérez Cabeza  3   4 , Kevin Bowrin  5 , Aleix Llorac Moix  6 , Mar Genís Gironès  6 , David Gasche  7 , Aurélie Millier  8 , Jean Tardu  8 , Mondher Toumi  9 , Jean-Baptiste Briere  10
Affiliations
Meta-Analysis

Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain

Carlos Escobar Cervantes et al. PLoS One. .

Abstract

Aims: A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain.

Methods: All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model.

Results: When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System.

Conclusion: These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.

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Conflict of interest statement

Kevin Bowrin is an employee of Bayer plc, Jean-Baptiste Briere is an employee of Bayer AG. Aurélie Millier and Jean Tardu are employees of Creativ-Ceutical, which received funding from Bayer AG. Mondher Toumi is a consultant for Creativ-Ceutical. Carlos Escobar Cervantes, Julio Martí-Almor and Alejandro Pérez Cabeza received consulting fees for their critical inputs on study design and results interpretation. C. Escobar reports personal fees from Bayer, Boehringer, Bristol Myers Squibb, Daiichi Sankyo and Pfizer outside the submitted work. J. Martí-Almor reports personal fees from Bayer, Daiichi Sankyo, Pfizer and Boehringer outside the submitted work. A. Pérez Cabeza reports personal fees from Bayer, Boehringer, Bristol Myers Squibb, Daiichi Sankyo and Pfizer outside the submitted work.

Figures

Fig 1
Fig 1. Rivaroxaban tornado diagram.
ICER, incremental cost-effectiveness ratio; VKA, vitamin K antagonist.
Fig 2
Fig 2. Dabigatran tornado diagram.
ICER, incremental cost-effectiveness ratio; VKA, vitamin K antagonist.
Fig 3
Fig 3. Apixaban tornado diagram.
ICER, incremental cost-effectiveness ratio; VKA, vitamin K antagonist.
Fig 4
Fig 4. Rivaroxaban incremental cost-effectiveness plane.
QALY, quality-adjusted life years.
Fig 5
Fig 5. Dabigatran incremental cost-effectiveness plane.
QALY, quality-adjusted life years.
Fig 6
Fig 6. Apixaban incremental cost-effectiveness plane.
QALY, quality adjusted life years.
See this image and copyright information in PMC

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