scholarly journals Cost-effectiveness of Apixaban for Stroke Prevention in Patients with Atrial Fibrillation in Algeria

10.36469/9797 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 39-54
Author(s):  
Yazid Aoudia ◽  
Thitima Kongnakorn ◽  
Evie Merinopoulou ◽  
Mohamed Said Bettayeb ◽  
Sid Ahmed Kherraf
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Stroke Prevention ◽  
Heart Rhythm ◽  
Cost Effective ◽  
European Medicines Agency ◽  
Economic Implications ◽  
Life Years ◽  
Increased Risk ◽  
Randomised Controlled

Background: Atrial fibrillation (AF) is a chronic sustained heart rhythm disorder associated with an increased risk of stroke. Apixaban, a new oral anticoagulant, was approved by the European Medicines Agency for prevention of stroke in patients with AF. The efficacy of apixaban has been investigated in randomised controlled trials. Objectives: The objective of this study was to estimate the economic implications of using apixaban compared to other anti-coagulations to reduce the risk of stroke in patients with AF from the perspective of the Algerian payer. Methods: A previously published Markov model was adapted to the Algerian setting. The model included patients for whom vitamin K antagonist (VKA) treatment is suitable and could initiate on acenocoumarol, rivaroxaban or apixaban, and those unsuitable for VKA treatment who could initiate on aspirin or apixaban. Over a lifetime time horizon, costs were estimated in Algerian dinars (DZD) and outcomes included life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Results: In the VKA suitable population, apixaban was estimated to be a dominant treatment option over rivaroxaban, providing a higher number of QALYs at lower costs, while when compared with acenocoumarol, an ICER of 3 672 059 DZD per QALY gained was estimated. Amongst those unsuitable for VKA therapy, the ICER was 2 061 863 DZD per QALY gained. Conclusion: Apixaban was found to be a cost-effective choice for stroke prevention in patients with AF in Algeria compared to acenocoumarol and rivaroxaban in the VKA suitable population and compared to aspirin in the VKA unsuitable population.

Cost-effectiveness and screening performance of ECG handheld machine in a population screening programme: The Belgian Heart Rhythm Week screening programme

2019 ◽  
Vol 26 (9) ◽  
pp. 964-972 ◽  
Author(s):  
Marco Proietti ◽  
Alessio Farcomeni ◽  
Peter Goethals ◽  
Christophe Scavee ◽  
Johan Vijgen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Screening Programme ◽  
Atrial Fibrillation Patient ◽  
Heart Rhythm ◽  
Cost Effective ◽  
Screening Procedure ◽  
Base Case ◽  
Number Needed To Screen ◽  
Life Years

Aims Overall, 40% of patients with atrial fibrillation are asymptomatic. The usefulness and cost-effectiveness of atrial fibrillation screening programmes are debated. We evaluated whether an atrial fibrillation screening programme with a handheld electrocardiogram (ECG) machine in a population-wide cohort has a high screening yield and is cost-effective. Methods We used a Markov-model based modelling analysis on 1000 hypothetical individuals who matched the Belgian Heart Rhythm Week screening programme. Subgroup analyses of subjects ≥65 and ≥75 years old were performed. Screening was performed with one-lead ECG handheld machine Omron® HeartScan HCG-801. Results In both overall population and subgroups, the use of the screening procedure diagnosed a consistently higher number of diagnosed atrial fibrillation than not screening. In the base-case scenario, the screening procedure resulted in 106.6 more atrial fibrillation patient-years, resulting in three fewer strokes, 10 more life years and five more quality-adjusted life years (QALYs). The number needed-to-screen (NNS) to avoid one stroke was 361. In subjects ≥65 years old, we found 80.8 more atrial fibrillation patient-years, resulting in three fewer strokes, four more life-years and five more QALYs. The NNS to avoid one stroke was 354. Similar results were obtained in subjects ≥75 years old, with a NNS to avoid one stroke of 371. In the overall population, the incremental cost-effectiveness ratio for any gained QALY showed that the screening procedure was cost-effective in all groups. Conclusions In a population-wide screening cohort, the use of a handheld ECG machine to identify subjects with newly diagnosed atrial fibrillation was cost-effective in the general population, as well as in subjects ≥65 and subjects ≥75 years old.

Abstract 200: Cost-Effectiveness of Newer Anticoagulants for Stroke Prevention in Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Brendan L Limone ◽  
William L Baker ◽  
Craig I Coleman
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Stroke Prevention ◽  
Indirect Comparison ◽  
Cost Effective ◽  
The United States ◽  
Base Case ◽  
Treatment Comparison ◽  
Newer Anticoagulants ◽  
The Cost

Background: A number of new anticoagulants for stroke prevention in atrial fibrillation (SPAF) have gained regulatory approval or are in late-stage development. We sought to conduct a systematic review of economic models of dabigatran, rivaroxaban and apixaban for SPAF. Methods: We searched the Medline, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment database along with the Tuft’s Registry through October 10, 2012. Included models assessed the cost-effectiveness of dabigatran (150mg, 110mg, sequential), rivaroxaban or apixaban for SPAF using a Markov model or discrete event simulation and were published in English. Results: Eighteen models were identified. All models utilized a lone randomized trial (or an indirect comparison utilizing a single study for any given direct comparison), and these trials were clinically and methodologically heterogeneous. Dabigatran 150mg was assessed in 9 of models, dabigatran 110mg in 8, sequential dabigatran in 9, rivaroxaban in 4 and apixaban in 4. Adjusted-dose warfarin (either trial-like, real-world prescribing or genotype-dosed) was a potential first-line therapy in 94% of models. Models were conducted from the perspective of the United States (44%), European countries (39%) and Canada (17%). In base-case analyses, patients typically were at moderate-risk of ischemic stroke, initiated anticoagulation between 65 and 73 years of age, and were followed for or near a lifetime. All models reported cost/quality-adjusted life-year (QALY) gained, and while 22% of models reported using a societal perspective, no model included costs of lost productivity. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110mg (n=4)/150mg (n=2); rivaroxaban (n=1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs (in 2012US$) vs. warfarin ranged from $3,547-$86,000 for dabigatran 150mg, $20,713-$150,000 for dabigatran 110mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. In addition, apixaban was demonstrated to be an economically dominant strategy compared to aspirin and to be dominant or cost-effective ($11,400-$25,059) vs. warfarin. Based on separate indirect treatment comparison meta-analyses, 3 models compared the cost-effectiveness of these new agents and reported conflicting results. Conclusions: Cost-effectiveness models of newer anticoagulants for SPAF have been extensively published. Models have frequently found newer anticoagulants to be cost-effective, but due to the lack of head-to-head trial comparisons and heterogeneity in clinical characteristic of underlying trials and modeling methods, it is currently unclear which of these newer agents is most cost-effective.

Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

2021 ◽  
Author(s):  
Xueyan Luo ◽  
Wei Xu ◽  
Quan Yuan ◽  
Han Lai ◽  
Chunji Huang
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Integrated Care ◽  
Mobile Health ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Years ◽  
Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

scholarly journals Predicting Cost-Effectiveness of Generic Versus Brand Dabigatran Using Pharmacometric Estimates among Patients with Atrial Fibrillation in the United States

2019 ◽  
Author(s):  
Ching-Yu Wang ◽  
Phuong N. Pham ◽  
Sarah Kim ◽  
Karthik Lingineni ◽  
Stephan Schmidt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Lifetime Cost ◽  
Systemic Exposure ◽  
Cost Effective ◽  
The United States ◽  
Payer Perspective ◽  
Life Years ◽  
Generic Medications ◽  
Newer Anticoagulants

ABSTRACTGeneric entry of newer anticoagulants is expected to decrease the costs of atrial fibrillation management. However, when making switches between brand and generic medications, bioequivalence failures are possible. The objectives of this study were to predict and compare the lifetime cost-effectiveness of brand dabigatran with hypothetical future generics. Markov micro-simulations were modified to predict the lifetime costs and quality-adjusted life years of patients on either brand or generic dabigatran from a U.S. private payer perspective. Event rates for generics were predicted using previously developed pharmacokinetic-pharmacodynamic models. The analyses showed that generic dabigatran with lower-than-brand systemic exposure was dominant. Meanwhile, generic dabigatran with extremely high systemic exposure was not cost-effective compared to the brand reference. Cost-effectiveness of generic medications cannot always be assumed as shown in this example. Combined use of pharmacometric and pharmacoeconomic models can assist in decision making between brand and generic pharmacotherapies.

Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: A Canadian payer perspective

2011 ◽  
Vol 105 (05) ◽  
pp. 908-919 ◽  
Author(s):  
Anuraag Kansal ◽  
Stuart Connolly ◽  
Siyang Peng ◽  
John Linnehan ◽  
Carole Bradley-Kennedy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Real World ◽  
Functional Disability ◽  
Dabigatran Etexilate ◽  
Cost Effective ◽  
Systemic Embolism ◽  
Clinical Events ◽  
Payer Perspective ◽  
Life Years

SummaryOral dabigatran etexilate is indicated for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) in whom anticoagulation is appropriate. Based on the RE-LY study we investigated the cost-effectiveness of Health Canada approved dabigatran etexilate dosing (150 mg bid for patients <80 years, 110 mg bid for patients ≥80 years) versus warfarin and “real-world” prescribing (i.e. warfarin, aspirin, or no treatment in a cohort of warfarin-eligible patients) from a Canadian payer perspective. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on a Canadian prospective study, published literature, and national statistics. Clinical events, summarized as events per 100 patient-years, quality-adjusted life years (QALYs), total costs, and incremental cost effectiveness ratios (ICER) were calculated. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages (0.49 dabigatran etexilate vs. 1.13 warfarin vs. 1.05 “real-world” prescribing) and fewer ischaemic strokes (4.40 dabigatran etexilate vs. 4.66 warfarin vs. 5.16 “real-world” prescribing) per 100 patient-years. The ICER of dabigatran etexilate was $10,440/QALY versus warfarin and $3,962/QALY versus “real-world” prescribing. This study demonstrates that dabigatran etexilate is a highly cost-effective alternative to current care for the prevention of stroke and systemic embolism among Canadian AF patients.

Abstract 17410: A Multiperspective Analysis of the Influence of Medicare Part D on the Cost-effectiveness of Dabigatran versus Warfarin

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brian M Salata ◽  
David W Hutton ◽  
Deborah A Levine ◽  
James B Froehlich ◽  
Geoffrey D Barnes
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Patient’S Perspective ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Introduction: Dabigatran and warfarin have been shown to be non-inferior for stroke prevention in atrial fibrillation (AF). We aimed to assess the cost perspectives of each payer (Medicare and patient) in relation to administration, monitoring and adverse outcomes for each medication. Hypothesis: We hypothesize that dabigatran 150 mg BID will be more cost-effective when compared to warfarin for both payers (Medicare and patient) regardless of Medicare Part D coverage. Methods: Using a Markov model, we performed a decision analysis comparing two treatment strategies in patients 65 years of age and older with AF: adjusted-dose warfarin and dabigatran 150 mg twice daily in Medicare patients with CHADS2 scores ≥ 1. Results are listed in 2013 US dollars, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). Patient movement between health states was modeled using 1-month cycles for 35 years or until death. Cost-effectiveness therapies were selected using a willingness to pay threshold of $50,000 per quality-adjusted life year gained. Results: For patients with Medicare Part D coverage, Quality-adjusted life expectancy was 10.74 QALYs with warfarin and 11.22 QALYs with 150 mg dabigatran BID. From Medicare’s perspective, total average costs were $59,684 and $59,284 for warfarin as well as $76,237 and $45,421 for dabigatran, in patients with and without Part D coverage, respectively. From Medicare’s perspective, the ICER comparing dabigatran with warfarin was $34,707 and -$29,065, for patients with and without Part D coverage, respectively. From the patient’s perspective, total costs were $33,466 and $33,866 for warfarin as well as $28,876 and $59,692 for dabigatran, in patients with and without Part D coverage, respectively. From the patient’s perspective, the ICER comparing dabigatran with warfarin was -$9,624 and $54,147, for patients with and without Part D coverage, respectively. Conclusions: In patients ≥ 65 years old with nonvalvular atrial fibrillation (NVAF) and at increased risk of stroke (CHAD2 score = 2), dabigatran 150 mg BID is more cost-effective for both Medicare and the patient, except for individual patients without Medicare Part D coverage.

Abstract 104: Cost-Effectiveness of Edoxaban vs. Rivaroxaban for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation (NVAF) in the US

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Jeffrey D Miller ◽  
Xin Ye ◽  
Gregory M Lenhart ◽  
Amanda M Farr ◽  
Oth V Tran ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Effective Treatment ◽  
Healthcare Cost ◽  
Major Bleeding ◽  
Stroke Prevention ◽  
Cost Effective ◽  
Base Case ◽  
Once Daily ◽  
Cost Effective Treatment

Background: Edoxaban and rivaroxaban for stroke prevention in non-valvular atrial fibrillation (NVAF) patients with CHADS 2 ≥2 have been evaluated in pivotal trials versus warfarin. This study assessed the cost-effectiveness of once-daily edoxaban (60 mg/30 mg dose-reduced) regimen versus rivaroxaban (20 mg/15 mg dose-reduced) for stroke prevention in patients with NVAF patients from a US health plan perspective. Methods: A Markov model simulated lifetime risk and treatment of stroke, systemic embolism, major bleeding, clinically relevant non-major bleeding, myocardial infarction, and death in NVAF patients treated with edoxaban or rivaroxaban. Efficacy and safety data were from a network meta-analysis using data from patients enrolled in ENGAGE AF-TIMI 48 and ROCKET-AF that were presented previously. 2015 wholesale acquisition cost (WAC) was used for edoxaban and rivaroxaban in the analysis. Healthcare cost and utility data were from published sources. Incremental cost-effectiveness ratios of <$50,000, $50,000-$150,000, and >$150,000 per quality-adjusted life year (QALY) gained were used as thresholds for highly cost-effective, cost-effective, and not cost-effective treatment option per guidance from the AHA/ACC statement on cost/value methodology in clinical practice guidelines and performance measures. Results: Edoxaban was dominant relative to rivaroxaban, such that it was associated with lower total healthcare cost and better effectiveness in terms of QALYs in the base case analysis (Table). Results were supported by probabilistic sensitivity analyses that showed edoxaban as either dominant or a highly cost-effective alternative (ICER<$50,000) to rivaroxaban 88.4% of the time. Conclusions: These results showed that once-daily edoxaban (60mg/30mg dose-reduced) regimen is a highly cost-effective treatment relative to rivaroxaban (20mg/15mg dose-reduced) for stroke prevention in NVAF patients.

scholarly journals Cost-effectiveness Analysis of Rivaroxaban versus Acenocoumarol in the Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation in Spain

10.36469/9823 ◽  
2016 ◽  
Vol 4 (1) ◽  
pp. 19-34 ◽  
Author(s):  
Carlos Rubio-Terrés ◽  
Ruth Graefenhain de Codes ◽  
Darío Rubio-Rodríguez ◽  
Thomas Evers ◽  
Santiago Grau Cerrato
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
National Health System ◽  
Cost Effective ◽  
Healthcare Setting ◽  
Clinical Results ◽  
Phase Iii ◽  
Pivotal Phase ◽  
System Perspective ◽  
Life Years

Objective: The aim of this study was to evaluate, from the Spanish National Health System perspective, the cost-effectiveness of rivaroxaban (20 mg/day) versus use of acenocoumarol (5 mg/day) for the treatment of patients with non-valvular atrial fibrillation (NVAF) at moderate to high risk for stroke. Methods: A Markov model was designed and populated with local cost estimates, efficacy and safety of rivaroxaban in stroke prevention in NVAF compared with adjusted-dose warfarin clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. Results: Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.289 vs. 0.300 events), intracranial bleeds (0.051 vs. 0.067), and myocardial infarctions (0.088 vs. 0.102) per patient compared with acenocoumarol. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.041 life-threatening events per patient, and increases of 0.103 life-years and 0.155 quality-adjusted lifeyears (QALYs) versus acenocoumarol treatment. This resulted in an incremental cost-effectiveness ratio of €7045 per QALY and €10 602 per life-year gained. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with acenocoumarol in 89.4% of cases should a willingness-to-pay threshold of €30 000/QALY gained be considered. Conclusions: The present analysis suggests that rivaroxaban is a cost-effective alternative to acenocoumarol therapy for the prevention of stroke and systemic embolisms in patients with NVAF in the Spanish healthcare setting.

scholarly journals Patient-level micro-simulation model for evaluating the future potential cost–effectiveness of pharmacy-based interventions in the control and management of diabetes-related complications in Canada

2020 ◽  
Author(s):  
Mohsen Yaghoubi ◽  
Kerry Mansell ◽  
Hassanali Vatanparast ◽  
Wu Zeng ◽  
Mehdi Javanbakht ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Simulation Model ◽  
Cost Effective ◽  
Potential Cost ◽  
Discounted Cost ◽  
Life Years ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Micro Simulation ◽  
The Cost

AbstractBackgroundThe increased risk of complications among diabetes patients poses a serious threat to population health. Pharmacy-based interventions can decrease the burden of diabetes and its related complications. This study evaluates the cost-effectiveness of pharmacy-based interventions and offers insights on the practicality of their adoption by health practitioners.MethodsWe developed population-based micro-simulation model using 2,931 patients with diabetes in Canada. We used the risk equations on the UK Prospective Diabetes Study (UKPDS) to estimate the incidence and mortality of four of the most common diabetes-related complications (heart failure, stroke, amputation, and blindness). We extrapolated the potential effects of pharmacy interventions on reducing time-varying risk factors for diabetes complications. Cost was quantified as the annual cost of complications; and, the cost associated with pharmacy-based interventions. The final outcomes were the incremental costs per quality-adjusted life years (QALY) gained. Both deterministic and probabilistic sensitivity analysis were conducted to examine the robustness of the ratio.ResultPharmacy-based interventions could prevent 155 preventable deaths, 159 strokes, 29 cases of blindness, 24 amputations, and 19 heart failures across the lifetime of 2,931 patients. In addition, an estimated 953 QALYs (0.32 per patient) would be gained among the intervention group. Per QALY, the incremental discounted cost is $3,928, suggesting that pharmacy-based interventions are likely cost-effective compared to usual care. At an ICER threshold of $50,000, over 92% of the simulation remains cost-effective.ConclusionPharmacist-based interventions targeted at addressing the development of diabetes-related complications among Canadian patients have the potential to offer a cost-effective strategy.

scholarly journals Cost‑effectiveness analysis of apixaban versus other NOACs for the prevention of stroke in Italian atrial fibrillation patients

2014 ◽  
Vol 15 (4) ◽  
pp. 101-112
Author(s):  
Lorenzo Pradelli ◽  
Mario Calandriello ◽  
Roberto Di Virgilio ◽  
Marco Bellone ◽  
Marco Tubaro
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Indirect Comparison ◽  
Cost Effective ◽  
Primary Outcome Measure ◽  
Sensitivity Analyses ◽  
Mortality Data ◽  
Trial Duration ◽  
Life Years ◽  
Clinical Risks

OBJECTIVES: The study evaluated the cost‑effectiveness of apixaban in preventing thromboembolic events in non‑valvular atrial fibrillation (NVAF) patients, as compared to other three available novel oral anticoagulant agents (NOACs), from the Italian Health System (SSN) perspective.METHODS: A previously published lifetime Markov model was adapted for the Italian context. Baseline clinical risks were assigned based on the demographic and clinical features of the patients; effectiveness and safety parameters derived from adjusted indirect comparison using warfarin as link. The main clinical events considered in the model are ischemic and hemorrhagic stroke, systemic thromboembolism, bleeds (both major and clinically relevant minor) and cardiovascular hospitalizations, besides treatment discontinuations. Expected survival was projected beyond trial duration using national mortality data adjusted for clinical risks and weighted by published utilities. Unit costs were collected from published Italian sources and actualized to 2013. Costs and health gains occurring after the first year were discounted at an annual 3.5% rate. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio (ICER), where effectiveness is measured in terms of life‑years and quality adjusted life‑years gained. Deterministic and probabilistic sensitivity analyses (DSA&PSA) were carried out.RESULTS: In the short to medium term, apixaban was associated with marginal LYs and QALYs gains and slight savings, as compared to other NOACs. However, as apixaban extended expected survival versus dabigatran (110mg), dabigatran (150mg) and rivaroxaban (0.13, 0.08, and 0.06 LYs or 0.11, 0.07, and 0.05 QALYs), expected total lifetime costs exceeded those of these comparators (€ 319, € 282, and € 16). Corresponding ICERs were estimated in € 2,911, € 3,882 and € 327 per QALY gained. The most influential parameter according to DSA was daily costs of NOACs, but the corresponding ICERs remained well below commonly accepted WTP values. In PSA, the probabilities of apixaban being cost effective with a WTP threshold of 20,000 €/QALY gained were 99%, 92% and 93% for the same comparisons.CONCLUSIONS: Apixaban is expected to be more effective than dabigatran and rivaroxaban in Italian NVAF population, and marginally more costly due to consume healthcare resources for a longer period of time. The ICERs have a high likelihood of being below conventional thresholds of WTP for health benefits of the SSN and suggest that apixaban is cost‑effective compared with other three available NOACs.

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