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Applied Health Economics and Health Policy
Erschienen in:

10.06.2024 | Original Research Article

Employing Real-World Evidence for the Economic Evaluation of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation in Thailand

verfasst von: Rungroj Krittayaphong, Unchalee Permsuwan

Erschienen in: Applied Health Economics and Health Policy | Ausgabe 5/2024

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Abstract

Background

This study aimed to assess the cost-effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) in comparison with warfarin using data from real practice based on the perspective of the health care system in Thailand.

Methods

A four-state Markov model encompassing well-controlled atrial fibrillation (AF), stroke and systemic embolism, major bleeding and death was utilised to forecast clinical and economic outcomes. Transitional probabilities, direct medical costs and utilities were derived from the real-world data of the ‘COOL-AF Thailand’ registry, Thailand’s largest nationwide registry spanning 27 hospitals. The cohort comprised AF patients. The primary outcomes assessed were total costs, life years, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio. All costs and outcomes were subject to an annual discount rate of 3.0%. A spectrum of sensitivity analyses was conducted.

Results

The mean age of the cohort was 68.8 ± 10.7 years. The NOACs group incurred a marginally lower total lifetime cost than the warfarin group (247,857 Thai baht [THB] vs 253,654 THB or 7137 USD vs 7304 USD) and experienced gains of 0.045 life years and 0.043 QALYs over the warfarin group. Given the lower cost and higher benefits associated with NOACs, this implies that NOAC treatment is a dominant strategy compared to warfarin for AF patients. At a ceiling ratio of 160,000 THB (4607 USD) per QALY, NOACs presented a 61.2% probability of being cost effective.

Conclusions

Non-vitamin K antagonist oral anticoagulants represent a cost-saving alternative to warfarin in the real clinical practice. However, with a probability of being cost effective below 65%, it suggests some parameter uncertainty regarding their overall cost effectiveness compared to warfarin.
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Literatur
1.
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217–21.PubMedCrossRef
2.
Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33(12):1500–10.PubMedCrossRef
3.
Krittayaphong R, Winijkul A, Methavigul K, Wongtheptien W, Wongvipaporn C, Wisaratapong T, et al. Risk profiles and pattern of antithrombotic use in patients with non-valvular atrial fibrillation in Thailand: a multicenter study. BMC Cardiovasc Disord. 2018;18(1):174.PubMedPubMedCentralCrossRef
4.
Tse HF, Teo WS, Siu CW, Chao TF, Park HW, Shimizu W, et al. Prognosis and treatment of atrial fibrillation in Asian cities: 1-year review of the Asia-Pacific Heart Rhythm Society atrial fibrillation registry. Europace. 2022;24(12):1889–98.PubMedCrossRef
5.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373–498.CrossRef
6.
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104–32.PubMedCrossRef
7.
Lip GYH, Banerjee A, Boriani G, Chiang CE, Fargo R, Freedman B, et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest. 2018;154(5):1121–201.PubMedCrossRef
8.
Chao TF, Joung B, Takahashi Y, Lim TW, Choi EK, Chan YH, et al. 2021 Focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary. Thromb Haemost. 2022;122(1):20–47.PubMedCrossRef
9.
Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2024;149(1):e1–156.PubMedCrossRef
10.
Liu T, Yang HL, Gu L, Hui J, Omorogieva O, Ren MX, et al. Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study. BMC Cardiovasc Disord. 2020;20(1):22.PubMedPubMedCentralCrossRef
11.
Bahuleyan CG, Namboodiri N, Jabir A, Lip GYH, Koshy AG, Shifas BM, et al. One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry. Indian Heart J. 2021;73(1):56–62.PubMedCrossRef
12.
Connock M, Stevens C, Fry-Smith A, Jowett S, Fitzmaurice D, Moore D, et al. Clinical effectiveness and cost-effectiveness of different models of managing long-term oral anticoagulation therapy: a systematic review and economic modelling. Health Technol Assessment (Winchester, Engl). 2007;11(38):iii–iv, ix–66.
13.
Singh SM, Wijeysundera HC. Cost-effectiveness of novel oral anticoagulants for stroke prevention in non-valvular atrial fibrillation. Curr Cardiol Rep. 2015;17(8):61.PubMedCrossRef
14.
Harrington AR, Armstrong EP, Nolan PE Jr, Malone DC. Cost-effectiveness of apixaban, dabigatran, rivaroxaban, and warfarin for stroke prevention in atrial fibrillation. Stroke. 2013;44(6):1676–81.PubMedCrossRef
15.
Kansal AR, Sorensen SV, Gani R, Robinson P, Pan F, Plumb JM, et al. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation. Heart. 2012;98(7):573–8.PubMedCrossRef
16.
Jarungsuccess S, Taerakun S. Cost-utility analysis of oral anticoagulants for nonvalvular atrial fibrillation patients at the police general hospital, Bangkok, Thailand. Clin Ther. 2014;36(10):1389-1394.e4.PubMedCrossRef
17.
Dilokthornsakul P, Nathisuwan S, Krittayaphong R, Chutinet A, Permsuwan U. Cost-effectiveness analysis of non-vitamin K antagonist oral anticoagulants versus warfarin in Thai patients with non-valvular atrial fibrillation. Heart Lung Circ. 2020;29(3):390–400.PubMedCrossRef
18.
Cameron D, Ubels J, Norstrom F. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Glob Health Action. 2018;11(1):1447828.PubMedPubMedCentralCrossRef
19.
McDougall JA, Furnback WE, Wang BCM, Mahlich J. Understanding the global measurement of willingness to pay in health. J Mark Access Health Policy. 2020;8(1):1717030.PubMedPubMedCentralCrossRef
20.
Thavorncharoensap M, Teerawattananon Y, Natanant S, Kulpeng W, Yothasamut J, Werayingyong P. Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter? Clinicoecon Outcomes Res CEOR. 2013;5:29–36.CrossRef
21.
Liao CT, Lee MC, Chen ZC, Ku LE, Wang JD, Toh HS. Cost-effectiveness analysis of oral anticoagulants in stroke prevention among patients with atrial fibrillation in Taiwan. Acta Cardiol Sin. 2020;36(1):50–61.PubMedPubMedCentral
22.
Krittayaphong R, Pumprueg S, Kaewkumdee P, Yindeengam A, Lip GY. Three-year outcomes of patients with non-valvular atrial fibrillation: the COOL-AF registry. J Geriatr Cardiol. 2023;20(3):163–73.PubMedPubMedCentralCrossRef
23.
Ho D, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw. 2011;42(8):1–28.CrossRef
24.
Briggs A, Claxton K, Sculpher M. Decision modeling methods for health economic evaluation. Oxford: Oxford University Press; 2006.CrossRef
25.
Riewpaiboon A. Standard cost lists for health technology assessment: Health Intervention and Technology Assessment Program (HITAP); 2011.
26.
27.
Pattanaphesaj J, Thavorncharoensap M, Ramos-Goñi JM, Tongsiri S, Ingsrisawang L, Teerawattananon Y. The EQ-5D-5L valuation study in Thailand. Expert Rev Pharmacoecon Outcomes Res. 2018;18(5):551–8.PubMedCrossRef
28.
Permsuwan U, Guntawongwan K, Buddhawongsa P. Handling time in economic evaluation studies. J Med Assoc Thailand. 2014;97(Suppl 5):S50–8.
29.
Limwattananon S. Sensitivity analysis for handling uncertainty in an economic evaluation. J Med Assoc Thailand. 2014;97(Suppl 5):S59–64.
30.
Koretsune Y, Etoh T, Katsuda Y, Suetsugu T, Kumeda K, Sakuma I, et al. Risk profile and 1-year outcome of newly diagnosed atrial fibrillation in Japan—insights from GARFIELD-AF. Circ J. 2018;83(1):67–74.PubMedCrossRef
31.
Bassand JP, Accetta G, Camm AJ, Cools F, Fitzmaurice DA, Fox KA, et al. Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. Eur Heart J. 2016;37(38):2882–9.PubMedPubMedCentralCrossRef
32.
Lip GY, Wang KL, Chiang CE. Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in Asian patients with atrial fibrillation: time for a reappraisal. Int J Cardiol. 2015;180:246–54.PubMedCrossRef
33.
Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet (Lond, Engl). 2014;383(9921):955–62.CrossRef
34.
Zhou H, Nie X, Jiang M, Dong W. Cost-effectiveness of anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation in mainland China. J Clin Pharm Ther. 2022;47(4):523–30.PubMedCrossRef
35.
Rattanachotphanit T, Limwattananon C, Waleekhachonloet O, Limwattananon P, Sawanyawisuth K. Cost-effectiveness analysis of direct-acting oral anticoagulants for stroke prevention in thai patients with non-valvular atrial fibrillation and a high risk of bleeding. Pharmacoeconomics. 2019;37(2):279–89.PubMedCrossRef
36.
Diamond GA, Kaul S. Cost, effectiveness, and cost-effectiveness. Circ Cardiovasc Qual Outcomes. 2009;2(1):49–54.PubMedCrossRef
37.
Turner HC, Archer RA, Downey LE, Isaranuwatchai W, Chalkidou K, Jit M, et al. An introduction to the main types of economic evaluations used for informing priority setting and resource allocation in healthcare: key features, uses, and limitations. Front Public Health. 2021;9: 722927.PubMedPubMedCentralCrossRef
38.
Di Cesare M, Jarvis JD, Scarlatescu O, Leng X, Zaidel EJ, Burrone E, et al. NOACs added to WHO’s essential medicines list: recommendations for future policy actions. Glob Heart. 2020;15(1):67.PubMedPubMedCentralCrossRef
39.
Neumann I, Schunemann HJ, Bero L, Cooke G, Magrini N, Moja L. Global access to affordable direct oral anticoagulants. Bull World Health Organ. 2021;99(9):653–60.PubMedPubMedCentralCrossRef
Metadaten
Titel
Employing Real-World Evidence for the Economic Evaluation of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation in Thailand
verfasst von
Rungroj Krittayaphong
Unchalee Permsuwan
Publikationsdatum
10.06.2024
Verlag
Springer International Publishing
Erschienen in
Applied Health Economics and Health Policy / Ausgabe 5/2024
Print ISSN: 1175-5652
Elektronische ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-024-00891-3

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