Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.17/2356
Título: Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal
Outros títulos: Custo-Efectividade dos Novos Anticoagulantes Orais na Fibrilhação Auricular em Portugal
Autor: Costa, J
Fiorentino, F
Caldeira, D
Inês, M
Lopes Pereira, C
Pinheiro, L
Vaz-Carneiro, A
Borges, M
Gouveia, M
Palavras-chave: CHLC FAR
Anticoagulants/therapeutic use
Atrial Fibrillation/drug therapy
Benzimidazoles/therapeutic use
Cost-Benefit Analysis
Dabigatran/therapeutic use
Pyrazoles/therapeutic use
Pyridones/therapeutic use
Stroke/drug therapy
Warfarin/therapeutic use
Data: 23-Nov-2015
Editora: Elsevier
Citação: Rev Port Cardiol. 2015; 34 (12): 723-737
Resumo: INTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.
Peer review: yes
URI: http://hdl.handle.net/10400.17/2356
DOI: 10.1016/j.repc.2015.07.004
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