The use of mathematical model approach to select direct oral anticoagulants in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.V Malchikova ◽  
N.S Maksimchuk-Kolobova ◽  
M.V Kazakovtseva
Keyword(s):  
Atrial Fibrillation ◽  
Mathematical Model ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Economic Effect ◽  
Economic Effectiveness ◽  
Stroke Treatment ◽  
Life Years ◽  
The Cost

Abstract Purpose To evaluate the clinical and economic effectiveness of direct oral anticoagulants (DOAC) - dabigatran/D, rivaroxaban/R, apixaban/A compared with warfarin/W in the treatment of atrial fibrillation (AF). Methods The mathematical model (MM) was used (decision-tree building- DTB) to assess the clinical and economic effectiveness of the DOAC use in comparison with W in the AF treatment. MM was based on the results of basic clinical trials on the use of D (RE-LY); R (ROCKET) and A (ARISTOTLE). MM was carried out on a time horizon of 5 years from the perspective of the healthcare system (HS). The method of cost-effectiveness analysis CER. CER = DC/Ef, CER is the cost-effectiveness balance of the alternative, DC is direct costs, Ef is the number of adjusted life years (ALY) and adjusted life years without complications (ALYC). Budget Impact Analysis. BIA = S (1) − S (2), BIA is the result of the analysis of “impact on the budget”, in monetary terms; S (l) – the total economic effect of the use of one drug, in monetary terms; S (2) – the total economic effect of the use of another drug, in monetary terms. Analysis of “lose opportunities”. MOA = ΔS/Costmin, MOA is the result of the analysis of “lose opportunities”, ΔS is the difference in the total economic effects of the two compared drugs, Costmin is the cost of using the lowest cost drugs. Results The MM showed that as a result of pair-wise comparison the DOAC and W, the greatest DC were in group of treatment with the W. The total costs when using D were 10.3% less and amounted to 4129711 against 4605164 rub. per 100 patients. The cost of using R is 5.2% less (4887744 against 5156589); using A by 10.9% (3946528 against 4433820). The greatest difference was due to the different costs of adverse drug reaction treatment (30–38% in the cost structure). In the D group, this cost component was less than the W -by 22.0%, in the R – by 10.9%, in the A – by 36.8%. Costs associated with ischemic stroke treatment were less then 28.1% in the D group. The strategy of using DOAK compared with W allows to provide a greater number of ALY and ALYC – 4, 34 and 4.3 when comparing D and W, 4.3 and 4.25 when R and W; and 4.25 and 4.2 – A and W. ALYC respectively – 3.92 and 3.79; 3.51 and 3.6; 3.9 and 3.74. The cost of ALY is 9516.65 against 10706.45 rub; 11,374.34/12123.81; 9,295.19/10547.31. The cost of ALYC respectively: 10,534.98 against 12150.83 rub.; 13,925.20/14733.11 and 10119.3/11855.13. The use of DOAK allows to save significant public funds, and the savings saved allow to treat the patients in addition by modern drugs. Savings up to 12% in 5 years, while up to 33 patients out of 1000 can be treated additionally. Conclusion DC resulting from the prevention of thromboembolic complications when using DOAC in comparison with W can be reduced by 28.1%, hemorrhagic complications by 36.8%. DOAC can save a greater number of ALY and ALYC at a lower cost. Funding Acknowledgement Type of funding source: None

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Vs. Vitamin K Antagonists in the Elderly With Atrial Fibrillation: Insights From the Evidence in a Real-World Setting

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue Wu ◽  
Chi Zhang ◽  
Zhi-Chun Gu
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Real World ◽  
Treatment Strategy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Effective ◽  
The Cost

Background: In the clinical setting, the economic benefits of direct oral anticoagulants (DOACs) in elderly patients with atrial fibrillation (AF) remain unclear. This study aimed to estimate and compare the cost-effectiveness of DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) and vitamin K antagonists (VKAs; warfarin) in preventing stroke among AF patients aged >75 years in real-world practice.Methods: A Markov model with a 10-year span was constructed to estimate the long-term clinical and economic outcomes among AF patients aged >75 years treated with DOACs and warfarin. The study was populated with a hypothetical cohort of 10,000 AF patients aged >75 years. Probabilities of clinical outcomes were obtained from the pooled observational studies (OSs), comparing DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) with VKAs. Other model inputs, including the utilities and the costs, were all estimated from public sources and the published literature. The costs, quality-adjusted life-years (QAYLs), and incremental cost-effectiveness ratios (ICER) were estimated for each treatment strategy. Subgroup analyses of individual DOACs and the scenario analysis were performed. Uncertainty was evaluated by deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA).Results: Compared to warfarin, DOACs were associated with a gain of 0.36 QALY at an additional cost of $15,234.65, resulting in an ICER of $42,318.47 per QALY. Sensitivity analysis revealed that the ICER was sensitive to the cost of DOACs. Direct oral anticoagulants also shifted from dominating to dominated status When their annual costs of DOACs were over $3,802.84 or the risk ratio of death compared to warfarin was over 1.077%/year. Probabilistic sensitivity analysis (PSA) suggested that DOACs had a 53.83 and 90.7% probability of being cost-effective when the willingness-to-pay threshold was set at $50,000 and $100,000, respectively. Among all the four individual DOACs, edoxaban treatment was revealed as the preferred treatment strategy for the AF patients aged over 75 years by yielding the most significant health gain with the relatively low total cost.Conclusions: Despite the high risk for major bleeding in elderly patients with AF, DOACs are more cost-effective treatment options than warfarin in real-world practice. Edoxaban was the preferred treatment strategy among four kinds of DOACs for AF patients aged over 75 years. Furthermore, beyond their safety profiles, the treatment benefits of DOACs assumed greater relevance and importance in older adults.

scholarly journals Cost‐effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongtao Wei ◽  
Can Cui ◽  
Xiangli Cui ◽  
Yi Liu ◽  
Dandan Li
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Oral Anticoagulants ◽  
Cost Effectiveness Analysis ◽  
Chinese Patients ◽  
Economic Point ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Abstract Background and objective To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF). Methods The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3–6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study. Results The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least. Conclusions In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

scholarly journals Cost-Effectiveness Analysis of Dabigatran, Rivaroxaban and Warfarin in the Prevention of Stroke in Patients with Atrial Fibrillation in China

2020 ◽  
Author(s):  
Hongtao Wei ◽  
Can Cui ◽  
Xiangli Cui ◽  
Yi Liu ◽  
Dandan Li
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Oral Anticoagulants ◽  
Cost Effectiveness Analysis ◽  
Chinese Patients ◽  
Economic Point ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Abstract Background and objective: To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation. Methods: the Markov model was constructed to compare the quality of life years of patients with dabigatran 110 and 150mg, twice a day, rivaroxaban 20mg, once a day, warfarin 3-6mg, once a day drug cost, and the cost of examination after taking the drug and the incremental cost of other treatments. Results: the total cost of warfarin, rivaroxaban, dabigatran for 110mg bid and 150mg bid was 37806.08 yuan, 210977.4 yuan, 167906.1 yuan and 244050.1 yuan, respectively. The QALYs available were 11.07 years, 15.46 years, 12.4 years and 15 years, respectively. The cost-effectiveness analysis of three new oral anticoagulants and warfarin showed that rivaroxaban compared with warfarin The incremental cost effectiveness ratio (ICER) is 39446.77 yuan / QALY, which is the advantage scheme and warfarin is the expansion disadvantage scheme. Conclusion: In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

scholarly journals Cost-effectiveness analysis of Dabigatran, Rivaroxaban and Warfarin in the prevention of Stroke in patients with Atrial Fibrillation in China

2021 ◽  
Author(s):  
Wei Hongtao ◽  
Can Cui ◽  
Xiangli Cui ◽  
Yi Liu ◽  
Dandan Li
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Oral Anticoagulants ◽  
Cost Effectiveness Analysis ◽  
Chinese Patients ◽  
Economic Point ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Abstract Background and objective: To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF).Methods: The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3-6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study.Results: The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110mg bid, and dabigatran 150mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least. Conclusion: In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

scholarly journals Cost-effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China

2020 ◽  
Author(s):  
Wei Hongtao ◽  
Can Cui ◽  
Xiangli Cui ◽  
Yi Liu ◽  
Dandan Li
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Oral Anticoagulants ◽  
Cost Effectiveness Analysis ◽  
Chinese Patients ◽  
Economic Point ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Abstract Background and objective: To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF).Methods: The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3-6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study.Results: The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110mg bid, and dabigatran 150mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least.Conclusion: In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

The cost-effectiveness of one-time opportunistic screening for atrial fibrillation in different age cohorts of inhabitants in Denmark aged 65 years and above: a Markov modelled analysis

2020 ◽  
Author(s):  
Lucca Katrine Sciera ◽  
Lars Frost ◽  
Lars Dybro ◽  
Peter Bo Poulsen
Keyword(s):  
Atrial Fibrillation ◽  
General Practice ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Population Data ◽  
National Registry ◽  
Opportunistic Screening ◽  
Age Cohorts ◽  
Life Years ◽  
The Cost

Abstract Aims The objective was to evaluate the cost-effectiveness of one-time opportunistic screening for atrial fibrillation (AF) in general practice in citizens aged ≥65 years in Denmark compared to a no-screening alternative following current Danish practice. Methods and results A decision tree and a Markov model were designed to simulate costs and quality-adjusted life years (QALYs) in a hypothetical cohort of citizens aged ≥65 years equivalent to the Danish population (1 M citizens) over the course of 19 years, using a healthcare and societal perspective. Share of detected AF patients following opportunistic screening was retrieved from a recent Danish screening study, whereas the risk stroke and bleedings in AF patients were based on population data from national registries and their associated costs was obtained from published national registry studies. The present study showed that one-time opportunistic screening for AF was more costly, but also more effective compared to a no-screening alternative. The analysis predicts that one-time opportunistic screening of all Danes aged ≥65 years potentially can identify an additional 10 300 AF patients and prevent 856 strokes in the period considered. The incremental cost of such a screening programme is €56.4 M, with a total gain of 6000 QALYs, resulting in an incremental cost-effectiveness ratio of €9400 per QALY gained. Conclusion Opportunistic screening in general practice in citizens aged ≥65 years in Denmark is cost-effective compared to a willingness-to-pay threshold of €22 000. The study and its findings support a potential implementation of opportunistic screening for AF at the general practitioner level in Denmark.

scholarly journals Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the UK

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001037 ◽  
Author(s):  
Claudia I Rinciog ◽  
Laura M Sawyer ◽  
Alexander Diamantopoulos ◽  
Mitchell S V Elkind ◽  
Matthew Reynolds ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
High Risk Population ◽  
Risk Population ◽  
Life Years ◽  
The Uk ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared with standard of care (SoC) for detecting atrial fibrillation (AF) in patients at high risk of stroke (CHADS2 >2), using a UK National Health Service (NHS) perspective.MethodsUsing patient characteristics and clinical data from the REVEAL AF trial, a Markov model assessed the cost-effectiveness of detecting AF with an ICM compared with SoC. Costs and benefits were extrapolated across modelled patient lifetime. Ischaemic and haemorrhagic strokes, intracranial and extracranial haemorrhages and minor bleeds were modelled. Diagnostic and device costs were included, plus costs of treating stroke and bleeding events and costs of oral anticoagulants (OACs). Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3.5% per annum. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken.ResultsThe total per-patient cost for ICM was £13 360 versus £11 936 for SoC (namely, annual 24 hours Holter monitoring). ICMs generated a total of 6.50 QALYs versus 6.30 for SoC. The incremental cost-effectiveness ratio (ICER) was £7140/QALY gained, below the £20 000/QALY acceptability threshold. ICMs were cost-effective in 77.4% of PSA simulations. The number of ICMs needed to prevent one stroke was 21 and to cause a major bleed was 37. ICERs were sensitive to assumed proportions of patients initiating or discontinuing OAC after AF diagnosis, type of OAC used and how intense the traditional monitoring was assumed to be under SoC.ConclusionsThe use of ICMs to identify AF in a high-risk population is cost-effective for the UK NHS.

scholarly journals Direct oral anticoagulants versus low molecular weight heparins for the treatment of cancer-associated thrombosis: a cost-effectiveness analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kaidireyahan Wumaier ◽  
Wenqian Li ◽  
Naifei Chen ◽  
Jiuwei Cui
Keyword(s):  
Molecular Weight ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Test Model ◽  
Low Molecular Weight Heparins ◽  
Gastrointestinal Malignancy ◽  
Cancer Associated Thrombosis ◽  
The Cost

Abstract Background Recently, direct oral anticoagulants (DOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using DOACs and low molecular weight heparins (LMWHs) for treating CAT from the perspective of the Chinese healthcare system. Methods A Markov model was constructed to estimate the cost-effectiveness of the two strategies with a 6-month and 5-year time horizon. Input parameters were either sourced from the clinical trial, published literature. The primary outcome of the model was reported as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to test model uncertainty. Results The 6-month cost of DOACs was $ 654.65 with 0.40 quality adjusted life-years (QALYs) while the 6-month cost of LMWHs was $USD 1719.31 with 0.37 QALYs. Similarly, treatment with DOACs had a lower cost ($USD 657.85 vs. $USD 1716.56) and more health benefits (0.40 QALYs vs. 0.37 QALYs) than treatment with LMWHs in a subgroup of patients with gastrointestinal malignancy. We found treatment with DOACs would result in a large reduction in cost ($USD 1447.22 vs. $USD 3374.70) but a small reduction in QALYs (3.07 QALYs vs. 3.09 QALYs) compared with LMWHs over a 5-year time frame, resulting in an ICER of $USD 112895.50/QALYs. Sensitivity analysis confirmed the robustness of the results. Conclusion As compared to LMWHs, DOACs can be a cost-saving anticoagulant choice for the treatment of CAT in the general oncology population and gastrointestinal malignancy population.

scholarly journals Economic evaluation of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
pp. bmjebm-2020-111634
Author(s):  
Rini Noviyani ◽  
Sitaporn Youngkong ◽  
Surakit Nathisuwan ◽  
Bhavani Shankara Bagepally ◽  
Usa Chaikledkaew ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Effective ◽  
Risk Of Bias

ObjectivesTo assess cost-effectiveness of direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF) by pooling incremental net benefits (INBs).DesignSystematic review and meta-analysis.SettingWe searched PubMed, Scopus and Centre for Evaluation of Value and Risks in Health Registry from inception to December 2019.ParticipantsPatients with AF.Main outcome measuresThe INB was defined as a difference of incremental effectiveness multiplied by willing to pay threshold minus the incremental cost; a positive INB indicated favour treatment. These INBs were pooled (stratified by level of country income, perspective, time-horizon, model types) with a random-effects model if heterogeneity existed, otherwise a fixed effects model was applied. Heterogeneity was assessed using Q test and I2 statistic. Risk of bias was assessed using the economic evaluations bias (ECOBIAS) checklist.ResultsA total of 100 eligible economic evaluation studies (224 comparisons) were included. For high-income countries (HICs) from a third-party payer (TPP) perspective, the pooled INBs for DOAC versus VKA pairs were significantly cost-effective with INBs (95% CI) of $6632 ($2961.67 to $10 303.72; I2=59.9%), $6353.24 ($4076.03 to $8630.45; I2=0%), $7664.58 ($2979.79 to $12 349.37; I2=0%) and $8573.07 ($1877.05 to $15 269.09; I2=0%) for dabigatran, apixaban, rivaroxaban and edoxaban relative to VKA, respectively but only dabigatran was significantly cost-effective from societal perspective (SP) with an INB of $11 746.96 ($2429.34 to $21 064.59; I2=52.4%). The pooled INBs of all comparisons for upper-middle income countries (UMICs) were not significantly cost-effective. The ECOBIAS checklist indicated that risk of bias was mostly low for most items with the exception of five items which should be less influenced on pooling INBs.ConclusionsOur meta-analysis provides comprehensive economic evidence that allows policy makers to generalise cost-effectiveness data to their local context. All DOACs may be cost-effective compared with VKA in HICs with TPP perspective. The pooling results produced moderate to high heterogeneity particularly in UMICs. Further studies are required to inform UMICs with SP.PROSPERO registeration numberCRD 42019146610.

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