Cost-Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non-Valvular Atrial Fibrillation (NVAF) in Iran

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS

ACS Applied Bio Materials Pub Date : 2024-06-24 DOI:10.1002/clc.24311

Amirmohammad Tajik, Azam Abbasi, Zahra Goudarzi, Azadeh Izadi-Moud, Mehdi Varmaghani

{"title":"Cost-Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non-Valvular Atrial Fibrillation (NVAF) in Iran","authors":"Amirmohammad Tajik, Azam Abbasi, Zahra Goudarzi, Azadeh Izadi-Moud, Mehdi Varmaghani","doi":"10.1002/clc.24311","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>This study evaluates the cost-effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non-valvular atrial fibrillation in Iran.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>A Markov model with a 30-year time horizon was employed to simulate and assess different treatment strategies' cost-effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality-adjusted life years (QALY) were assessed using an EQ-5D questionnaire. This study utilized a cost-effectiveness threshold of $11 134 per QALY.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Apixaban demonstrated superior cost-effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost-effectiveness ratio for comparing Apixaban to Warfarin was calculated at −1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban's cost-effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024−2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study shows that Apixaban is a cost-effective option for stroke prevention in non-valvular atrial fibrillation patients in Iran compared to Warfarin.</p>\n </section>\n </div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11194975/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/clc.24311","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

This study evaluates the cost-effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non-valvular atrial fibrillation in Iran.

Method

A Markov model with a 30-year time horizon was employed to simulate and assess different treatment strategies' cost-effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality-adjusted life years (QALY) were assessed using an EQ-5D questionnaire. This study utilized a cost-effectiveness threshold of $11 134 per QALY.

Results

Apixaban demonstrated superior cost-effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost-effectiveness ratio for comparing Apixaban to Warfarin was calculated at −1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban's cost-effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024−2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results.

Conclusion

This study shows that Apixaban is a cost-effective option for stroke prevention in non-valvular atrial fibrillation patients in Iran compared to Warfarin.

Abstract Image

查看原文本刊更多论文

阿哌沙班和利伐沙班对比华法林预防伊朗非瓣膜性心房颤动 (NVAF) 患者中风的成本效益和预算影响分析。

导言：本研究评估了与华法林相比，阿哌沙班和利伐沙班在预防伊朗非瓣膜性心房颤动患者中风方面的成本效益：方法：采用马尔可夫模型，以 30 年的时间跨度来模拟和评估不同治疗策略的成本效益。研究对象包括伊朗非瓣膜性心房颤动成人患者，他们是通过专家会诊、医院就诊和档案记录审查确定的。直接医疗成本、直接非医疗成本和间接成本均包括在内。质量调整生命年（QALY）采用 EQ-5D 问卷进行评估。本研究采用的成本效益阈值为每 QALY 11 134 美元：阿哌沙班的成本效益优于利伐沙班和华法林。与华法林组相比，阿哌沙班和利伐沙班组 30 年的总成本较低（126.18 美元和 109.99 美元对 150.49 美元）。然而，阿哌沙班获得的总质量调整生命年高于其他组（0.134 对 0.133 和 0.116）。阿哌沙班与华法林的增量成本效益比为-1332.83，低于11 134美元的阈值，表明阿哌沙班具有成本效益。敏感性分析证实了研究结果的稳健性，ICER 始终低于阈值。在使用阿哌沙班的 5 年内（2024-2028 年），增量成本从第一年的 70 250 296 美元开始，逐渐上升到第五年的 71 770 662 美元。对 DSA 和 PSA 进行了评估，以证明结果的稳健性：本研究表明，与华法林相比，阿哌沙班是伊朗非瓣膜性心房颤动患者预防卒中的一种经济有效的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

ACS Applied Bio Materials Chemistry-Chemistry (all)

CiteScore

9.40

自引率

2.10%

发文量

464