Chia-Te Liao1,2, Mei-Chuan Lee3, Zhih-Cherng Chen1,4, Li-Jung Elizabeth Ku2, Jung-Der Wang2, Han Siong Toh5,6. 1. Department of Cardiology, Chi Mei Medical Center. 2. Department of Public Health, College of Medicine, National Cheng Kung University. 3. Department of Pharmacy, Chi Mei Medical Center. 4. Department of Pharmacy, Chia Nan University of Pharmacy and Science. 5. Department of Intensive Care Medicine, Chi Mei Medical Center. 6. Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
Abstract
BACKGROUND: Non-vitamin K oral antagonist anticoagulants (NOACs) have been widely used in stroke prevention in atrial fibrillation (SPAF). The aim of this study was to compare the pharmacoeconomic impact of oral anticoagulants (OACs) including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in SPAF in Taiwan. METHODS: A decision tree, Markov model, and multiple sensitivity analyses were used to project the lifetime costs and quality-adjusted life years (QALYs) of OACs. Transitional probabilities were derived from a systematic review and network meta-analysis for Asian populations. Utilities and costs were obtained from published studies and the Taiwan National Health Insurance Research Database. Threshold of the willingness to pay (WTP) at USD 20,000 was applied to evaluate the results. RESULTS: In base-case analysis, warfarin had the lowest cost at $13,363 ± 4,036, and edoxaban 60 mg produced the most QALYs at 11.92 ± 1.98. The incremental cost-effectiveness ratios of dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg, and edoxaban 60 mg versus warfarin were $6,415, $4,225, $4,115 and $5,458 per QALY gained, respectively. Monte Carlo analysis revealed that dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg and edoxaban 60 mg were most cost-effective at 21.9%, 27.1%, 23.6%, and 27.4% of $20,000 compared to warfarin. CONCLUSIONS: From a Taiwan national payer perspective, all NOACs are cost-effective substitutes for warfarin in SPAF. However, the likelihood of cost-effective iterations for NOACs is highly driven by their market prices at the time and different WTP thresholds of policymakers.
BACKGROUND: Non-vitamin K oral antagonist anticoagulants (NOACs) have been widely used in stroke prevention in atrial fibrillation (SPAF). The aim of this study was to compare the pharmacoeconomic impact of oral anticoagulants (OACs) including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in SPAF in Taiwan. METHODS: A decision tree, Markov model, and multiple sensitivity analyses were used to project the lifetime costs and quality-adjusted life years (QALYs) of OACs. Transitional probabilities were derived from a systematic review and network meta-analysis for Asian populations. Utilities and costs were obtained from published studies and the Taiwan National Health Insurance Research Database. Threshold of the willingness to pay (WTP) at USD 20,000 was applied to evaluate the results. RESULTS: In base-case analysis, warfarin had the lowest cost at $13,363 ± 4,036, and edoxaban 60 mg produced the most QALYs at 11.92 ± 1.98. The incremental cost-effectiveness ratios of dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg, and edoxaban 60 mg versus warfarin were $6,415, $4,225, $4,115 and $5,458 per QALY gained, respectively. Monte Carlo analysis revealed that dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg and edoxaban 60 mg were most cost-effective at 21.9%, 27.1%, 23.6%, and 27.4% of $20,000 compared to warfarin. CONCLUSIONS: From a Taiwan national payer perspective, all NOACs are cost-effective substitutes for warfarin in SPAF. However, the likelihood of cost-effective iterations for NOACs is highly driven by their market prices at the time and different WTP thresholds of policymakers.
Authors: D M Witt; T Delate; N P Clark; C Martell; T Tran; M A Crowther; D A Garcia; W Ageno; E M Hylek Journal: J Thromb Haemost Date: 2010-04 Impact factor: 5.824
Authors: Anders Gustavsson; Mikael Svensson; Frank Jacobi; Christer Allgulander; Jordi Alonso; Ettore Beghi; Richard Dodel; Mattias Ekman; Carlo Faravelli; Laura Fratiglioni; Brenda Gannon; David Hilton Jones; Poul Jennum; Albena Jordanova; Linus Jönsson; Korinna Karampampa; Martin Knapp; Gisela Kobelt; Tobias Kurth; Roselind Lieb; Mattias Linde; Christina Ljungcrantz; Andreas Maercker; Beatrice Melin; Massimo Moscarelli; Amir Musayev; Fiona Norwood; Martin Preisig; Maura Pugliatti; Juergen Rehm; Luis Salvador-Carulla; Brigitte Schlehofer; Roland Simon; Hans-Christoph Steinhausen; Lars Jacob Stovner; Jean-Michel Vallat; Peter Van den Bergh; Peter Van den Bergh; Jim van Os; Pieter Vos; Weili Xu; Hans-Ulrich Wittchen; Bengt Jönsson; Jes Olesen Journal: Eur Neuropsychopharmacol Date: 2011-09-15 Impact factor: 4.600
Authors: Christopher B Granger; John H Alexander; John J V McMurray; Renato D Lopes; Elaine M Hylek; Michael Hanna; Hussein R Al-Khalidi; Jack Ansell; Dan Atar; Alvaro Avezum; M Cecilia Bahit; Rafael Diaz; J Donald Easton; Justin A Ezekowitz; Greg Flaker; David Garcia; Margarida Geraldes; Bernard J Gersh; Sergey Golitsyn; Shinya Goto; Antonio G Hermosillo; Stefan H Hohnloser; John Horowitz; Puneet Mohan; Petr Jansky; Basil S Lewis; Jose Luis Lopez-Sendon; Prem Pais; Alexander Parkhomenko; Freek W A Verheugt; Jun Zhu; Lars Wallentin Journal: N Engl J Med Date: 2011-08-27 Impact factor: 91.245
Authors: Robert P Giugliano; Christian T Ruff; Eugene Braunwald; Sabina A Murphy; Stephen D Wiviott; Jonathan L Halperin; Albert L Waldo; Michael D Ezekowitz; Jeffrey I Weitz; Jindřich Špinar; Witold Ruzyllo; Mikhail Ruda; Yukihiro Koretsune; Joshua Betcher; Minggao Shi; Laura T Grip; Shirali P Patel; Indravadan Patel; James J Hanyok; Michele Mercuri; Elliott M Antman Journal: N Engl J Med Date: 2013-11-19 Impact factor: 91.245
Authors: Siti Norain Azahar; Saperi Sulong; Wan Asyraf Wan Zaidi; Norliza Muhammad; Yusof Kamisah; Norliana Masbah Journal: Int J Environ Res Public Health Date: 2022-01-19 Impact factor: 3.390