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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial
Paul Dorian1, Thitima Kongnakorn2, Hemant Phatak3
1University of Toronto, St Michael's Hospital Toronto, Ontario, Canada dorianp@smh.ca.
European Heart Journal
|February 12, 2014
Summary
Apixaban offers a cost-effective alternative for stroke prevention in atrial fibrillation (AF) patients, improving life expectancy and quality-adjusted life years (QALYs) compared to warfarin and aspirin.
Area of Science:
- Pharmacoeconomics
- Cardiovascular Medicine
- Clinical Trials
Background:
- Warfarin, a vitamin K antagonist (VKA), is the standard for stroke prevention in atrial fibrillation (AF).
- Aspirin is recommended for low-risk or warfarin-unsuitable patients.
- Apixaban shows superior efficacy and reduced bleeding compared to warfarin and aspirin.
Purpose of the Study:
- To evaluate the cost-effectiveness of apixaban versus warfarin and aspirin for stroke prevention in AF patients from a UK payer perspective.
Main Methods:
- A lifetime Markov model was utilized to assess pharmacoeconomic impact.
- Data from ARISTOTLE and AVERROES trials informed clinical events, mortality, and utility rates.
- The model compared apixaban against warfarin (for VKA-suitable patients) and aspirin (for VKA-unsuitable patients).
Main Results:
- Apixaban is projected to increase life expectancy and quality-adjusted life years (QALYs) compared to both warfarin and aspirin.
- These benefits are associated with an increased lifetime drug acquisition cost.
- The incremental cost-effectiveness ratios (ICERs) were £11,909/QALY gained versus warfarin and £7,196/QALY gained versus aspirin.
Conclusions:
- Apixaban represents a cost-effective alternative to warfarin and aspirin for stroke prevention in AF patients.
- This conclusion holds true for both VKA-suitable and VKA-unsuitable patient populations.
- Sensitivity analyses confirmed the robustness of these findings.
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