Atreja Nipun, Johannesen Kasper, Subash Rupesh, Bektur Carina, Hagan Melissa, Hines Dionne M, Dunnett Iulia, Stawowczyk Ewa
Bristol Myers Squibb Company, NJ, USA.
Bristol Myers Squibb Company, Stockholm, Sweden.
J Comp Eff Res. 2025 Jan;14(1):e240163. doi: 10.57264/cer-2024-0163. Epub 2024 Nov 28.
Warfarin and direct-acting oral anticoagulants (DOACs) are widely prescribed to patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of stroke and systemic embolism (SE). This study aimed to assess the cost-effectiveness of apixaban compared with warfarin, dabigatran and rivaroxaban, for patients with NVAF from a US healthcare payer (Medicare) perspective. A cohort-level Markov model was developed based on a previously published model, for the US setting, factoring in anticipated price decreases due to market entry of generic drugs. Two retrospective cohort studies in US Medicare patients provided inputs to quantify clinical events in the base case setting and in a scenario analysis. For this study, equal value of life-years (evLYs) and health years in total (HYT) were used. Cost-effectiveness was assessed based on a willingness-to-pay threshold of $100,000 per evLY gained (evLYG) or HYT gained (HYTG). Apixaban treatment was associated with gains of 2.23, 1.08 and 1.72 evLYs and 2.26, 1.08 and 1.73 HYTs, compared with warfarin, dabigatran and rivaroxaban, respectively. In the base case analysis from a Medicare perspective, apixaban was cost-effective (i.e., value for money) compared with warfarin, dabigatran and rivaroxaban, with corresponding incremental cost-effectiveness ratio (ICER) per evLYG (and HYTG) of $10,501 ($10,350), $7809 ($7769) and $758 ($768), respectively. When a societal perspective was included, and in a scenario analysis using US Medicare data from the Ray study to quantify treatment effects, apixaban dominated rivaroxaban (i.e., less expensive and more effective) in terms of ICER per evLYG (and HYTG). Using dynamic pricing assumptions, treatment with apixaban compared with warfarin, dabigatran and rivaroxaban was associated with incremental evLYs and HYT and represents a cost-effective treatment option in patients with NVAF, from a US healthcare payer (Medicare) perspective.
华法林和直接口服抗凝剂（DOACs）被广泛用于非瓣膜性心房颤动（NVAF）患者，以降低中风和全身性栓塞（SE）的风险。本研究旨在从美国医疗保健支付方（医疗保险）的角度，评估阿哌沙班与华法林、达比加群和利伐沙班相比，对于NVAF患者的成本效益。基于之前发表的模型，针对美国的情况开发了一个队列水平的马尔可夫模型，同时考虑到由于仿制药进入市场导致的预期价格下降。两项针对美国医疗保险患者的回顾性队列研究为量化基础病例设置和情景分析中的临床事件提供了数据输入。在本研究中，使用了生命年等价值（evLYs）和总健康年（HYT）。基于每获得一个evLY（evLYG）或HYT（HYTG）支付意愿阈值为100,000美元来评估成本效益。与华法林、达比加群和利伐沙班相比，阿哌沙班治疗分别带来2.23、1.08和1.72个evLYs以及2.26、1.08和1.73个HYTs的收益。从医疗保险的角度进行的基础病例分析中，与华法林、达比加群和利伐沙班相比，阿哌沙班具有成本效益（即性价比高），每获得一个evLYG（和HYTG）的相应增量成本效益比（ICER）分别为10,501美元（10,350美元）、7809美元（7769美元）和758美元（768美元）。当纳入社会视角，并在使用Ray研究中的美国医疗保险数据进行情景分析以量化治疗效果时，就每获得一个evLYG（和HYTG）的ICER而言，阿哌沙班在成本效益方面优于利伐沙班（即成本更低且效果更好）。使用动态定价假设，从美国医疗保健支付方（医疗保险）的角度来看，与华法林、达比加群和利伐沙班相比，阿哌沙班治疗可带来增量evLYs和HYT，是NVAF患者具有成本效益的治疗选择。
