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Current Cardiology Reports
Erschienen in: Current Cardiology Reports 8/2015

01.08.2015 | Invasive Electrophysiology and Pacing (EK Heist, Section Editor)

Cost-Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Non-Valvular Atrial Fibrillation

verfasst von: Sheldon M. Singh, Harindra C. Wijeysundera

Erschienen in: Current Cardiology Reports | Ausgabe 8/2015

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Abstract

Recently, novel oral anticoagulants (NOACs) have been approved for stroke prevention in patients with atrial fibrillation (AF). Although these agents overcome some disadvantages of warfarin, they are associated with increased costs. In this review, we will provide an overview of the cost-effectiveness of NOACs for stroke prevention in AF. Our comments and conclusions are limited to studies directly comparing all available NOACs within the same framework. The available cost-effectiveness analyses suggest that NOACs are cost-effective compared to warfarin, with apixaban likely being most favorable. However, significant limitations in these models are present and should be appreciated when interpreting their results.
Literatur
1.
Go A. Prevalence of atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.PubMedCrossRef
2.
Miyasaka Y, Barnes ME, Bersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:119–25.PubMedCrossRef
3.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8.PubMedCrossRef
4.
Pan X, Simon TA, Hamilton M, et al. Comparison of costs and discharge outcomes for patients hospitalized for ischemic or hemorrhagic stroke with or without atrial fibrillation in the United States. J Thromb Thrombolysis. 2014. doi:10.​1007/​s11239-014-1144-8.PubMedCentralPubMed
5.
Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27:1760–4.PubMedCrossRef
6.
Miller PS, Andersson FL, Kalra L. Are cost benefits of anticoagulation for stroke prevention in atrial fibrillation underestimated? Stroke. 2005;36:360–6.PubMedCrossRef
7.
Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients with non-valvular atrial fibrillation. Ann Intern Med. 2007;146:857–67.PubMedCrossRef
8.
Xu Y, Holbrook AM, Simpson CS, et al. Prescribing patterns of novel oral anticoagulation following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ Open. 2013;1:E115–9.PubMedCentralPubMedCrossRef
9.
Baczek VL, Chen WT, Kluger J, et al. Predictors of warfarin use in atrial fibrillation in the United States: a systematic review and metaanalysis. BMC Fam Pract. 2012;13:5.PubMedCentralPubMedCrossRef
10.••
Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomized trials. Lancet. 2014;383:955–62. This meta-analysis provides an excellent summary of the clinical benefits of NOACs from their clinical trials.PubMedCrossRef
11.
Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.PubMedCrossRef
12.
Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–91.PubMedCrossRef
13.
Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.PubMedCrossRef
14.
Guigliano RP, Ruff CT, Braunwald E, et al. Endoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093–104.CrossRef
15.•
Verma A, Cairns JA, Mitchell LB, et al. 2014 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol. 2014;30:1114–30. Excellent guidelines summarizing the care of patients with AF.PubMedCrossRef
16.
Camm AJ, Lip GYH, De Caterina R, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33:2719–47.PubMedCrossRef
17.
18.
19.
20.
21.
Grosse SD. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev Pharmacoecon Outcomes Res. 2008;8:165–78.PubMedCrossRef
22.
Anderson JL, Heidenreich PA, Barnett PG, et al. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association task Force on Performance Measures and Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2304–22.PubMedCrossRef
23.
Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992;146:473–81.PubMedCentralPubMed
24.
25.
Harrington AR, Armstrong EP, Nolan PE, Malone D. Cost-effectiveness of apixaban, dabigatran, rivaroxaban and warfarin for stroke prevention in atrial fibrillation. Stroke. 2013;44:1676–81.PubMedCrossRef
26.•
Canestaro WJ, Patrick AR, Avron J, et al. Cost-effectiveness of oral anticoagulants for treatment of atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2013;6:724–31. This is cost-effectiveness analysis from a US perspective provides an excellent analysis of its limitations. It provides an excellent framework for reading future cost-effectiveness analysis papers.PubMedCrossRef
27.•
Coyle D, Coyle K, Cameron C, et al. Cost-effectiveness of new oral anticoagulants compared with warfarin in preventing stroke and other cardiovascular events in patients with atrial fibrillation. Value Health. 2013;16:498–506. This is cost-effectiveness analysis from a Canadian perspective provides an excellent analysis of its limitations. It provides an excellent framework for reading future cost-effectiveness analysis papers.PubMedCrossRef
28.
Lip GYH, Konknakorn T, Phatak H, et al. Cost-effectiveness of apixaban versus other new oral anticoagulants for stroke prevention in atrial fibrillation. Clin Ther. 2014;36:192–230.PubMedCrossRef
29.
Rognoni C, Marchetti M, Quaglini S, et al. Apixaban, dabigatran, and rivaroxiban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis. Clin Drug Investig. 2014;39:9–17.CrossRef
30.
Pan X, Kachroo S, Liu X, et al. Real world discontinuation rates with apixaban versus warfarin, dabigatran or rivaroxiban among atrial fibrillation patients newly initiated on anticoagulation therapy. JACC. 2014;63:A415.CrossRef
31.
Boehringer Ingelheim Canada Ltd. Product monograph–Pradax. January 27, 2012.
32.
Briggs AH, Claxton K, Sculpher MJ. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.
33.
Briggs AH, Weinstein MC, Fenwick EA, et al. Model parameter estimation and uncertainty analysis: a report of the ISPOR‐SMDM Modeling Good Research Practices Task Force Working Group‐6. Med Decis Making. 2012;32:722–32.PubMedCrossRef
34.
Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
35.••
Micieli A, Bennell MC, Pham B, et al. Identifying future research priorities using value of information analyses: left atrial occlusion devices in atrial fibrillation. J Am Heart Assoc. 2014;3, e001031. This study provides an excellent overview of value of information analyses using stroke prevention in atrial fibrillation to highlight important concepts.PubMedCentralPubMedCrossRef
36.••
Limone B, Bajker WL, Mearns ES, et al. Common flaws in published cost-effectiveness models of pharmacologic stroke prevention in atrial fibrillation. J Clin Epidemiol. 2014;67:1093–102. This study provides an excellent review of the limitations of cost-effectiveness analyses in atrial fibrillation.PubMedCrossRef
37.
Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273:408–12.PubMedCrossRef
38.
Wallentin L, Yusuf S, Ezekowitz MD, et al. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalized ratio control for stroke prevention in atrial fibrillation: an analysis of the RELY trial. Lancet. 2010;376:975–83.PubMedCrossRef
39.
You JHS. Novel oral anticoagulants versus warfarin therapy at various levels of anticoagulation control in atrial fibrillation—a cost effectiveness analysis. J Gen Intern Med. 2013;29:438–46.PubMedCentralPubMedCrossRef
40.••
Singh SM, Micieli A, Wijeysundera HC. Economic evaluation of percutaneous left atrial appendage occlusion, dabigatran, and warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. Circulation. 2013;127:2414–23. This study was the first to provide a framework to evaluate pharmacologic and non-pharmacologic methods of stroke reduction in patients with atrial fibrillation.PubMedCrossRef
Metadaten
Titel
Cost-Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Non-Valvular Atrial Fibrillation
verfasst von
Sheldon M. Singh
Harindra C. Wijeysundera
Publikationsdatum
01.08.2015
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 8/2015
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-015-0618-4

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