Cost-effectiveness and budget impact analysis of switching from apixaban to rivaroxaban treatment among patients with nonvalvular atrial fibrillation in a German healthcare setting.

IF 1.9 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Rupesh Subash, Thomas Strakosch, Michelle Zhang, Melissa Hagan, Elke Dworatzek, Agnes Kisser, Vasileios Vasilopoulos, Chloe Salter, Carissa Dickerson, Ewa Stawowczyk
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Abstract

Aim: Direct oral anticoagulant (DOAC) switching often occurs in patients with nonvalvular atrial fibrillation (NVAF) for medical and nonmedical reasons. Limited data describe the economic consequences of DOAC switching in patients with NVAF. This study evaluates the cost-effectiveness and budget impact of initiating apixaban and switching to rivaroxaban versus initiating and continuing apixaban for patients with NVAF, from a German payer perspective. Materials & methods: Built on an existing model, a cohort-level lifetime Markov model was developed, including dynamic pricing assumptions to account for anticipated generic entry of DOACs. The modeled population (n = 1000) included German patients with NVAF, eligible for oral anticoagulation, who initiated on apixaban. The primary model outcome was the incremental cost-effectiveness ratio, assessed using cost per quality-adjusted life year (QALY) gained and a willingness-to-pay threshold of €48,750/QALY. A secondary model outcome was a 5-year budget impact analysis. Results: Switching patients from apixaban to rivaroxaban led to 285 additional events per 1000 patient years, resulting in 0.079 fewer QALYs and higher total costs per patient (€21,357 vs €16,390 for apixaban continuers). In the base case analysis (with generic pricing assumptions), switching from apixaban to rivaroxaban was dominated (i.e., less effective and more costly) by continuing apixaban. In the budget impact analysis (with generic pricing assumptions), switching from apixaban to rivaroxaban led to additional cumulative costs of €490 per patient over 5 years. Conclusion: Despite the introduction of generic discounting, switching patients with NVAF from apixaban to rivaroxaban led to higher total costs and fewer QALYs under base case assumptions, meaning apixaban switchers were dominated by apixaban continuers from a German payer perspective. Switching patients from apixaban to rivaroxaban also led to greater budget impact over 5 years.

德国医疗机构非瓣膜性房颤患者从阿哌沙班转为利伐沙班治疗的成本-效果和预算影响分析
目的:直接口服抗凝剂(DOAC)切换经常发生在非瓣膜性心房颤动(NVAF)患者的医疗和非医疗原因。有限的数据描述了非瓣膜性房颤患者DOAC转换的经济后果。本研究从德国付款人的角度评估了非瓣膜性房颤患者启动阿哌沙班并改用利伐沙班与启动并继续使用阿哌沙班的成本效益和预算影响。材料和方法:在现有模型的基础上,开发了一个队列级终身马尔可夫模型,其中包括动态定价假设,以考虑doac的预期一般进入。建模人群(n = 1000)包括符合口服抗凝治疗条件的德国非瓣膜性房颤患者,他们开始使用阿哌沙班。主要模型结果是增量成本效益比,使用获得的每个质量调整生命年(QALY)成本和支付意愿阈值48,750欧元/QALY进行评估。第二个模型结果是5年预算影响分析。结果:将患者从阿哌沙班转换为利伐沙班导致每1000患者年额外发生285个事件,导致QALYs减少0.079,每位患者的总成本增加(阿哌沙班继续治疗为21,357欧元,而阿哌沙班继续治疗为16,390欧元)。在基本案例分析中(基于通用定价假设),从阿哌沙班转向利伐沙班主要是继续阿哌沙班(即效果较差且成本较高)。在预算影响分析中(采用仿制药定价假设),从阿哌沙班转向利伐沙班导致5年内每位患者额外累积成本490欧元。结论:尽管引入了仿制折扣,但在基本情况假设下,将非瓣瓣性心律不全患者从阿哌沙班转到利伐沙班会导致更高的总成本和更少的QALYs,这意味着从德国付款人的角度来看,阿哌沙班切换者主要是阿哌沙班继续者。将患者从阿哌沙班转换为利伐沙班也导致5年内更大的预算影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of comparative effectiveness research
Journal of comparative effectiveness research HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.50
自引率
9.50%
发文量
121
期刊介绍: Journal of Comparative Effectiveness Research provides a rapid-publication platform for debate, and for the presentation of new findings and research methodologies. Through rigorous evaluation and comprehensive coverage, the Journal of Comparative Effectiveness Research provides stakeholders (including patients, clinicians, healthcare purchasers, and health policy makers) with the key data and opinions to make informed and specific decisions on clinical practice.
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