scholarly journals Budget impact analysis of apixaban versus other NOACs for the prevention of stroke in Italian atrial fibrillation patients

2014 ◽  
Vol 15 (1S) ◽  
pp. 5-14
Author(s):  
Lorenzo Pradelli ◽  
Mario Calandriello ◽  
Roberto Di Virgilio ◽  
Marco Bellone ◽  
Marco Tubaro
Keyword(s):  
Atrial Fibrillation ◽  
Patient Population ◽  
Impact Analysis ◽  
Budget Impact ◽  
Health Care Expenditure ◽  
Indirect Comparison ◽  
Budget Impact Analysis ◽  
Experimental Population ◽  
Italian Population ◽  
Treatment Comparison

OBJECTIVE: This study aims to perform a budget impact analysis of the use of three available novel oral anticoagulant agents (NOACs) for preventing thromboembolic events in Italian patients with non‑valvular atrial fibrillation (NVAF).METHODS: Estimated Italian population of patients was run through a previously published lifetime decision tree/Markov model simulating their treatment with the available therapeutic options: dabigatran at two dose levels (110 mg/bid for the over 80 years old, 150 mg/bid for younger NVAF patients), rivaroxaban (20 mg/uid), and apixaban (5 mg/bid). Effectiveness and safety estimates derive from an adjusted indirect treatment 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. Epidemiological data and unit costs, actualized to 2013, are collected from Italian published sources. The budget impact analysis evaluates the financial impact of apixaban introduction by comparing expected 1,2, and 3 years costs in hypothetical scenarios: with and without apixaban. Italian NVAF patient population estimation is based on official apixaban reimbursement criteria, applying the characteristics of the trial population to national epidemiologic data. Numbers of patients for each regimen are estimated by projecting share evolution. Sensitivity analysis is performed on an alternative non‑experimental population of NVAF patients.RESULTS: Among available NOACs, apixaban was expected to be the least expensive in an estimated patient population of 364,000 Italian patients, allowing for savings of € 1,180,549, € 3,841,429 and € 5,368,918 at 1,2, and 3 years, respectively. Results of the simulation run on an alternative non‑experimental population of NVAF patients yields comparable estimates.CONCLUSIONS: The different safety and effectiveness profiles of the three available NOACs emerging from the adjusted indirect comparison indicate that apixaban could improve health care expenditure control while maintaining or increasing therapeutic appropriateness in the Italian NVAF population.

scholarly journals Budget Impact Analysis Of Apixaban Versus Other Noacs For The Prevention Of Stroke In Italian Non-Valvular Atrial Fibrillation Patients

2014 ◽  
Vol 17 (7) ◽  
pp. A479
Author(s):  
L. Pradelli ◽  
M. Calandriello ◽  
Virgilio R. Di ◽  
M. Bellone ◽  
M. Tubaro
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis

scholarly journals Budget Impact Analysis of Rivaroxaban in the Prevention of Stroke in Non-Valvular Atrial Fibrillation Patients in Italy

2013 ◽  
Vol 16 (7) ◽  
pp. A519
Author(s):  
S. Capri ◽  
M. Veneziano ◽  
W.G. Ricciardi ◽  
A. D’Ausilio ◽  
M.P Pedone ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis

scholarly journals Budget impact analysis resulting from the use of dabigatran etexilate in preventing stroke in patients with non-valvular atrial fibrillation in Italy

2012 ◽  
Vol 13 (3) ◽  
pp. 121-131
Author(s):  
Francesco Mennini ◽  
Sergio Russo ◽  
Andrea Marcellusi
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Vitamin K Antagonists ◽  
Dabigatran Etexilate ◽  
Oral Anticoagulants ◽  
Budget Impact Analysis ◽  
Cumulative Number ◽  
Stroke Treatment ◽  
Human Cost

Background: atrial fibrillation (AF) is the most common form of alteration in cardiac rhythm and associated with more severe episodes of stroke. Treatment with oral anticoagulants vitamin K antagonists (VKA) such as warfarin, is nowadays the therapy of choice for stroke prevention in patients with AF, but dabigatran etexilate (DE) 150 mg twice daily was more clinically effective than warfarin in reducing the risk of stroke or systemic embolism, ischaemic stroke and vascular mortality whereas DE 110 mg twice daily was non-inferior to warfarin.Aim: to assess the affordability of the use of DE for the Italian NHS, in patients with non-valvular AF (NVAF) through a budget impact analysis (BIA).Methods: the BIA in a timeframe of 5 years was divided into 3 scenarios (1: current management of patients with NVAF; 2: all patients with NVAF treated with VKA; 3: all patients with NVAF treated with DE). The population considered is the one with indication for anticoagulation. Analysis is from the NHS perspective: therefore, indirect costs are excluded.Results: the underuse of oral anticoagulation, associated with the difficulty in keeping the patients treated with VKA within an acceptable therapeutic range, results in an enormous social and human cost, represented by a total of more than 63,000 strokes cumulated in the 5-year period considered. The cumulative cost for the scenario 1 over the 5-year period is over € 2.3 billion. In the scenario 2 the number of strokes avoided per year increases by -5,219 compared to no treatment (-2,368 compared to scenario 1), although the number of events remains high (about 10,000 events/year). In the 5-year observation period the scenario 2 would result in a reduction in the total number of strokes (-12,323 events vs. scenario 1), and savings for the NHS of around 95 million Euros compared to scenario 1. In the Scenario 3 there is a reduction of more than 38,600 of the total cumulative number of strokes vs. the scenario 1 and over 26,200 vs. scenario 2, and savings for the NHS at the fifth year of observation of circa 174 million Euros vs. scenario 1 and 123 million Euros vs. scenario 2.Conclusion: DE in Italy is economically sustainable, as it allows savings for the NHS in the management of patients with NVAF from the second year vs. no treatment and vs. treatment with VKA

scholarly journals COMPARATIVE PHARMACOECONOMIC ANALYSIS OF RIVAROXABAN AND WARFARIN USAGE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

2020 ◽  
Vol 26 (3) ◽  
pp. 37-47
Author(s):  
V. V. Arkhipov ◽  
D. A. Sychev
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Impact Analysis ◽  
Budget Impact ◽  
Pharmacoeconomic Analysis ◽  
International Normalized Ratio ◽  
Cardiovascular Complications ◽  
Pharmacoeconomic Evaluation ◽  
Budget Impact Analysis ◽  
Number Of Patients

Objective: complex pharmacoeconomic evaluation of warfarin replacement with rivaroxaban one of the direct oral anticoagulant (DOAC) for the treatment of patients with non-valvular atrial fibrillation and high risk of thromboembolia with poor international normalized ratio control.Materials and methods: A pharmacoeconomic model was designed to evaluate clinical outcomes of rivaroxaban therapy in compare with warfarin (with poor international normalized ratio control), economic impact was also calculated using budget impact analysis. Direct medical costs included drug costs, inpatient costs and costs of patient rehabilitation with cardiovascular complications. Moreover, indirect costs were simulated, including Gross Domestic Product loss due to disability or mortality of patients. Results were calculated on total number of patients from Russian Federation with non-valvular atrial fibrillation and high risk of thromboembolism, receiving rivaroxaban and warfarin (total of 278,175 patients). Patients with non-valvular atrial fibrillation on other anticoagulant therapies (130,305 patients) were not included in the analysis. Modeling horizon was 12 months.Results: in the analyzed population replacement of warfarin with poor international normalized ratio control with rivaroxaban makes it possible to additionally prevent 3,778 stroke events (-33% in compare with warfarin), 170 events of systemic thromboembolisms (-31%), 1,977 events of fatal bleeding (-11%) and 247 events of myocardial infarctions (-6%). Generally, patients transfer to rivaroxaban therapy reduces mortality by 30% (2,908 cases). Budget impact analysis demonstrated, that despite of the increased drug therapy costs by 2,306.1 million RUR, replacement of warfarin in the part of patients with rivaroxaban reduces costs, related to the complications treatment by 543.0 million RUR, rehabilitation costs - by 461.6 million RUR, INR control costs - by 480.3 million RUR, decline in GDP due to disability and mortality - by 2,988.5 million RUR. Thereby, replacement of patients with poor international normalized ratio control from warfarin to rivaroxaban reduces costs, related to the complications treatment of atrial fibrillation and GDP loss by 2,174.0 million rub.Conclusion: Warfarin replacement with rivaroxaban in patients with non-valvular atrial fi brillation and high risk of thromboembolism with poor international normalized ratio control is the most efficient from clinical and economic points.

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