PMID- 24221805
OWN - NLM
STAT- MEDLINE
DCOM- 20150212
LR  - 20211021
IS  - 1573-742X (Electronic)
IS  - 0929-5305 (Linking)
VI  - 37
IP  - 4
DP  - 2014 May
TI  - Comparison of cost-effectiveness of anticoagulation with dabigatran, rivaroxaban 
      and apixaban in patients with non-valvular atrial fibrillation across countries.
PG  - 507-23
LID - 10.1007/s11239-013-0989-6 [doi]
AB  - We did a cost-utility analysis for the new oral anticoagulants (NOACs) in the 
      German population based on the quality-adjusted life years (QALY), total costs, 
      and incremental cost-effectiveness ratios (ICER). The aim of our investigation 
      was to examine cost-utility for current German drug market costs and compared to 
      other countries. Outcome data were taken from dabigatran's RE-LY, rivaroxaban's 
      ROCKET AF, and apixaban's ARISTOTLE trials. A Markov decision model, the Monte 
      Carlo simulation (MCS), and further sensitivity analyses were used to simulate 
      comparisons between NOACs over a follow up period of 20 years. The main 
      perspective used for the analyses is from a German public health care insurance 
      perspective. The base-case analyses of a 65 years old person with a CHADS2 score 
      >1 resulted in 7.56-7.64 QALYs gained for warfarin. NOACs added 0.04-0.19 QALYs. 
      Total costs for warfarin ranged from 7622 to 9069<euro> and for NOACs from 19537 
      to 20048<euro>. The sensitivity analysis indicated that current German market 
      costs for the NOACs exceed a willingness-to-pay threshold of (hypothetical) 
      50000<euro>/QALY in all treatment regimen. The MCS showed willingness-to-pay 
      thresholds from 60500<euro>/QALY for apixaban to 278000<euro>/QALY for dabigatran 
      110 mg bid, with values for dabigatran 150 mg bid and rivaroxaban in between. In 
      conclusion, from a German public health care insurance perspective current market 
      costs are high in relation to the quality of life gained. These results from 
      clinical studies (efficacy) remain to be confirmed under real life conditions 
      (effectiveness).
FAU - Krejczy, Martin
AU  - Krejczy M
AD  - Department of Clinical Pharmacology, Medical Faculty Mannheim, 
      Ruprecht-Karls-University Heidelberg, Maybachstrasse 14, 68169, Mannheim, 
      Germany.
FAU - Harenberg, Job
AU  - Harenberg J
FAU - Marx, Svetlana
AU  - Marx S
FAU - Obermann, Konrad
AU  - Obermann K
FAU - Frolich, Lutz
AU  - Frolich L
FAU - Wehling, Martin
AU  - Wehling M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Anticoagulants)
RN  - 0 (Benzimidazoles)
RN  - 0 (Morpholines)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridones)
RN  - 0 (Thiophenes)
RN  - 11P2JDE17B (beta-Alanine)
RN  - 3Z9Y7UWC1J (apixaban)
RN  - 9NDF7JZ4M3 (Rivaroxaban)
RN  - I0VM4M70GC (Dabigatran)
SB  - IM
MH  - *Anticoagulants/economics/therapeutic use
MH  - *Benzimidazoles/economics/therapeutic use
MH  - Costs and Cost Analysis
MH  - Dabigatran
MH  - Female
MH  - Germany
MH  - Humans
MH  - Male
MH  - *Models, Econometric
MH  - *Morpholines/economics/therapeutic use
MH  - *Pyrazoles/economics/therapeutic use
MH  - *Pyridones/economics/therapeutic use
MH  - Retrospective Studies
MH  - Rivaroxaban
MH  - *Thiophenes/economics/therapeutic use
MH  - beta-Alanine/*analogs & derivatives/economics/therapeutic use
EDAT- 2013/11/14 06:00
MHDA- 2015/02/13 06:00
CRDT- 2013/11/14 06:00
PHST- 2013/11/14 06:00 [entrez]
PHST- 2013/11/14 06:00 [pubmed]
PHST- 2015/02/13 06:00 [medline]
AID - 10.1007/s11239-013-0989-6 [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2014 May;37(4):507-23. doi: 10.1007/s11239-013-0989-6.