Fernando Lanas1, Constanza Castro2, Carlos Vallejos3, Luis Bustos4, Catherine de La Puente3, Monica Velasquez3, Carlos Zaror5. 1. Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Universitat Autònoma de Barcelona, Spain. Electronic address: lanastomas@gmail.com. 2. Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Hospital Hernán Herminda Martin, Chillán, Chile. 3. Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile. 4. Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Departamento de Salud Pública, Universidad La Frontera. 5. Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad La Frontera, Chile.
Abstract
OBJECTIVE: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost-utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature. RESULTS: Incremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol. CONCLUSION: The use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.
OBJECTIVE: Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost-utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system. STUDY DESIGN AND SETTING: We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature. RESULTS: Incremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol. CONCLUSION: The use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.
Authors: Carlos Jerjes-Sanchez; Ramon Corbalan; Antonio C P Barretto; Hector L Luciardi; Jagan Allu; Laura Illingworth; Karen S Pieper; Gloria Kayani Journal: Clin Cardiol Date: 2019-04-09 Impact factor: 2.882