Iñaki Lekuona1, Manuel Anguita2, José Luis Zamorano3, José Manuel Rodríguez4, Paloma Barja de Soroa5, Ferran Pérez-Alcántara6. 1. Servicio de Cardiología, Hospital de Galdakao, Usansolo, Vizcaya, Spain. 2. Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain. 3. Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. 4. Market Access Department, Daiichi Sankyo Europe GmbH, Munich, Germany. 5. Departamento de Acceso, Daiichi Sankyo España S.A., Madrid, Spain. 6. Oblikue Consulting S.L., Barcelona, Spain. Electronic address: ferran.perez@oblikue.com.
Abstract
INTRODUCTION AND OBJECTIVES: To assess the cost-effectiveness of edoxaban vs acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain. METHODS: Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, haemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources. RESULTS: Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was 3916€, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was 11 518€, within the thresholds commonly considered cost-effective in Spain (25 000-30 000 €/QALY). The robustness of the results was confirmed by various sensitivity analyses. CONCLUSIONS: Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.
INTRODUCTION AND OBJECTIVES: To assess the cost-effectiveness of edoxaban vs acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain. METHODS: Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, haemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources. RESULTS:Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was 3916€, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was 11 518€, within the thresholds commonly considered cost-effective in Spain (25 000-30 000 €/QALY). The robustness of the results was confirmed by various sensitivity analyses. CONCLUSIONS:Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.
Authors: M Rosa Dalmau Llorca; Carina Aguilar Martín; Noèlia Carrasco-Querol; Zojaina Hernández Rojas; Emma Forcadell Drago; Dolores Rodríguez Cumplido; Elisabet Castro Blanco; Alessandra Queiroga Gonçalves; José Fernández-Sáez Journal: Int J Environ Res Public Health Date: 2021-05-26 Impact factor: 3.390