Verhoef, T;
Redekop, WK;
Hasrat, F;
de Boer, A;
Maitland-van der Zee, AH;
(2014)
Cost-effectiveness of new oral anticoagulants for stroke prevention in patients with atrial fibrillation in two different European healthcare settings.
American Journal of Cardiovascular Drugs
, 14
(6)
pp. 451-462.
10.1007/s40256-014-0092-1.
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Abstract
Objectives: To investigate the cost-effectiveness of apixaban, rivaroxaban and dabigatran, compared to coumarin derivatives for stroke prevention in patients with atrial fibrillation in a country with specialized anticoagulation clinics (The Netherlands) and in a country without these clinics (the United Kingdom). Methods: A decision-analytic Markov model was used to analyse the cost-effectiveness of apixaban, rivaroxaban and dabigatran compared to coumarin derivatives in The Netherlands and the United Kingdom over a lifetime horizon. Results: In the Netherlands, the use of rivaroxaban, apixaban or dabigatran increased health by 0.166, 0.365 and 0.374 quality-adjusted life-years (QALYs) compared to coumarin derivatives, but also increased costs by €5,681, €4,754 and €5,465, respectively. The incremental cost-effectiveness ratios (ICERs) were €34,248, €13,024 and €14,626 per QALY gained. In the United Kingdom, health was increased by 0.302, 0.455 and 0.461 QALYs and the incremental costs were similar for all three new oral anticoagulants (€5,118 to €5,217). The ICERs varied from €11,172 to €16,949 per QALY gained. In The Netherlands, apixaban had the highest chance (37%) to be cost-effective at a threshold of €20,000 and in the United Kingdom this chance was 41% for dabigatran. The quality of care reflected in time in therapeutic range had an important influence on the ICER. Conclusions: Apixaban, rivaroxaban and dabigatran are cost-effective alternatives to coumarin derivatives in the United Kingdom, while in The Netherlands, only apixaban and dabigatran could be considered cost-effective. The cost-effectiveness of the new oral anticoagulants is largely dependent on the setting and quality of local anticoagulant care facilities.
| Type: | Article |
|---|---|
| Title: | Cost-effectiveness of new oral anticoagulants for stroke prevention in patients with atrial fibrillation in two different European healthcare settings |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1007/s40256-014-0092-1 |
| Publisher version: | http://dx.doi.org/10.1007/s40256-014-0092-1 |
| Language: | English |
| Additional information: | © The Author(s) 2014. This article is published with open access at Springerlink.com This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
| UCL classification: | UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1450779 |
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