Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal

João Costa; Francesca Fiorentino; Daniel Caldeira; Mónica Inês; Catarina Lopes Pereira; Luís Pinheiro; António Vaz-Carneiro; Margarida Borges; Miguel Gouveia

doi:10.1016/j.repc.2015.07.004

Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal

João Costa^*
, Francesca Fiorentino
, Daniel Caldeira
, Mónica Inês
, Catarina Lopes Pereira
, Luís Pinheiro
, António Vaz-Carneiro
, Margarida Borges
, Miguel Gouveia

^*Autor correspondente para este trabalho

Resultado de pesquisa › revisão de pares

10 Citações (Scopus)

50 Transferências (Pure)

Resumo

Introdução e objetivos: Os non-vitamin K antagonist oral anticoagulants (NOAC) foram recentemente comparticipados para a fibrilhação auricular não-valvular (FA), sendo relevante determinar o seu custo-efetividade para a realidade portuguesa. Métodos: Foi especificado um modelo Markov para simular a progressão dos doentes com FA no decurso da sua vida. Os dados de efetividade relativa para os eventos acidente vascular cerebral (isquémico e hemorrágico), hemorragia (intracraniana, outras hemorragias major ehemorragias não-major clinicamente relevantes), enfarte agudo do miocárdio e descontinuação do tratamento foram obtidos por comparações indiretas entre o apixabano, o dabigatrano e orivaroxabano (comparador comum: varfarina). As fontes dos dados de consumo de recursos de saúde foram a base de dados dos grupos de diagnóstico homogéneo e painel de peritos. Estimou-se os anos de vida ganhos, anos de vida ajustados pela qualidade (QALY), custos diretos e rácios de custo-efetividade incremental (ICER). Resultados: Os anos de vida ganhos e os QALY foram maiores com apixabano, com um ICER versus varfarina e dabigatrano de 5529 € /QALY e 9163 € /QALY, respetivamente. O apixabano foi dominante versus o rivaroxabano (maiores ganhos em saúde e menores custos). Estes resultados foram robustos nas análises de sensibilidade realizadas, tendo o apixabano uma probabilidade de 70% de ser custo-efetivo (threshold: 20 000 € /QALY) versus o conjunto das restantes opções esterapêuticas.

Idioma original	English
Páginas (de-até)	723-737
Número de páginas	15
Revista	Revista Portuguesa de Cardiologia
Volume	34
Número de emissão	12
DOIs	https://doi.org/10.1016/j.repc.2015.07.004 https://doi.org/10.1016/j.repce.2015.11.005
Estado da publicação	Publicado - 1 dez. 2015

ODS da ONU

Este resultado contribui para o(s) seguinte(s) Objetivo(s) de Desenvolvimento Sustentável

ODS 3 Boa saúde e bem-estar

Keywords

Anticoagulantes orais
Fibrilhação auricular
Custo-efetividade
Anos de vida ajustados pela qualidade

Acesso ao documento

10.1016/j.repc.2015.07.004Licença:
10.1016/j.repce.2015.11.005Licença:

20556355_PTFinal published version, 1,48 MBLicença:
20556355_ENFinal published version, 901 KBLicença:

http://hdl.handle.net/10400.14/33536Licença:

Outros arquivos e links

https://www.scopus.com/pages/publications/84983134282

Citação

Costa, J., Fiorentino, F., Caldeira, D., Inês, M., Pereira, C. L., Pinheiro, L., Vaz-Carneiro, A., Borges, M., & Gouveia, M. (2015). Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal. Revista Portuguesa de Cardiologia, 34(12), 723-737. https://doi.org/10.1016/j.repc.2015.07.004, https://doi.org/10.1016/j.repce.2015.11.005

@article{84e19fe6fb6e44da80bafb37d4b55a09,

title = "Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal",

abstract = "Introduction and Objectives Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. Methods A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70\% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. Conclusions Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.",

keywords = "Anticoagulantes orais, Fibrilha{\c c}{\~a}o auricular, Custo-efetividade, Anos de vida ajustados pela qualidade, Oral anticoagulants, Atrial fibrillation, Cost-effectiveness, Quality-adjusted life years",

author = "Jo{\~a}o Costa and Francesca Fiorentino and Daniel Caldeira and M{\'o}nica In{\^e}s and Pereira, \{Catarina Lopes\} and Lu{\'i}s Pinheiro and Ant{\'o}nio Vaz-Carneiro and Margarida Borges and Miguel Gouveia",

year = "2015",

month = dec,

day = "1",

doi = "10.1016/j.repc.2015.07.004",

language = "English",

volume = "34",

pages = "723--737",

journal = "Revista Portuguesa de Cardiologia",

issn = "0870-2551",

publisher = "Sociedade Portuguesa De Cardiologia",

number = "12",

}

Costa, J, Fiorentino, F, Caldeira, D, Inês, M, Pereira, CL, Pinheiro, L, Vaz-Carneiro, A, Borges, M & Gouveia, M 2015, 'Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal', Revista Portuguesa de Cardiologia, vol. 34, n.º 12, pp. 723-737. https://doi.org/10.1016/j.repc.2015.07.004, https://doi.org/10.1016/j.repce.2015.11.005

TY - JOUR

T1 - Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal

AU - Costa, João

AU - Fiorentino, Francesca

AU - Caldeira, Daniel

AU - Inês, Mónica

AU - Pereira, Catarina Lopes

AU - Pinheiro, Luís

AU - Vaz-Carneiro, António

AU - Borges, Margarida

AU - Gouveia, Miguel

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Introduction and Objectives Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. Methods A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. Conclusions Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

AB - Introduction and Objectives Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. Methods A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. Conclusions Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

KW - Anticoagulantes orais

KW - Fibrilhação auricular

KW - Custo-efetividade

KW - Anos de vida ajustados pela qualidade

KW - Oral anticoagulants

KW - Atrial fibrillation

KW - Cost-effectiveness

KW - Quality-adjusted life years

UR - https://www.scopus.com/pages/publications/84983134282

U2 - 10.1016/j.repc.2015.07.004

DO - 10.1016/j.repc.2015.07.004

M3 - Article

C2 - 26616542

AN - SCOPUS:84983134282

SN - 0870-2551

VL - 34

SP - 723

EP - 737

JO - Revista Portuguesa de Cardiologia

JF - Revista Portuguesa de Cardiologia

IS - 12

ER -

Cost-effectiveness of non-Vitamin K antagonist oral anticoagulants for atrial fibrillation in Portugal

Resumo

ODS da ONU

Keywords

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