Servicio de Cardiología, Hospital La Paz, Madrid, Spain.
Servicio de Cardiología, Hospital del Mar, Barcelona, Spain.
PLoS One. 2022 Apr 20;17(4):e0266658. doi: 10.1371/journal.pone.0266658. eCollection 2022.
A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain.
All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model.
When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System.
These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.
采用马尔可夫模型评估利伐沙班、达比加群和阿哌沙班在西班牙非瓣膜性心房颤动患者中的真实世界成本效益。这些非维生素 K 拮抗剂口服抗凝剂分别与维生素 K 拮抗剂用于预防卒中。
所有输入均源自真实世界研究：基础患者特征、临床事件发生率以及维生素 K 拮抗剂治疗方案的持久性。对真实世界研究的荟萃分析提供了利伐沙班、达比加群和阿哌沙班的治疗效果和持久性数据，每项数据均与维生素 K 拮抗剂治疗进行比较。该模型考虑了终生 3 个月的周期。模型结果包括不同的成本、质量调整生命年和生命年获益。进行了敏感性分析以检验模型的稳健性。
与维生素 K 拮抗剂相比，利伐沙班的增量成本为 77 欧元，增量质量调整生命年为 0.08。增量成本每质量调整生命年为 952 欧元。对于相同的比较，达比加群增量成本每质量调整生命年为 4612 欧元。最后，与维生素 K 拮抗剂相比，阿哌沙班增量成本每质量调整生命年为 32015 欧元。敏感性分析证实了基础病例结果的稳健性。考虑到西班牙国家卫生系统的一项成本效益研究，在支付意愿阈值为每获得 1 个质量调整生命年 22000 欧元的情况下，利伐沙班、达比加群和阿哌沙班相对于维生素 K 拮抗剂具有成本效益的概率分别为 94%、86%和 35%。
从西班牙国家卫生系统的角度来看，这些结果表明利伐沙班和达比加群在预防非瓣膜性心房颤动中的卒中方面相对于维生素 K 拮抗剂具有成本效益。
