Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France


Autoři: Kevin Bowrin aff001;  Jean-Baptiste Briere aff002;  Laurent Fauchier aff003;  Craig Coleman aff004;  Aurélie Millier aff005;  Mondher Toumi aff006;  Emilie Clay aff005;  Pierre Levy aff007
Působiště autorů: Bayer Plc, Reading, England, United Kingdom aff001;  Bayer AG, Berlin, Germany aff002;  Cardiologie, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France aff003;  University of Connecticut, School of Pharmacy, Storrs, Connecticut, United States of America aff004;  Creativ-Ceutical, Paris, France aff005;  Aix-Marseille University, Marseille, France aff006;  Université Paris-Dauphine, PSL Research University, LEDa-LEGOS, Paris, France aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225301

Souhrn

Objective

The objective was to assess the real-world cost-effectiveness of rivaroxaban, versus vitamin K antagonists (VKAs), for stroke prevention in patients with atrial fibrillation (AF) from a French national health insurance perspective.

Methods

A Markov model was developed with a lifetime horizon and cycle length of 3 months. All inputs were drawn from real-world evidence (RWE) studies: data on baseline patient characteristics at model entry were obtained from a French RWE study, clinical event rates as well as persistence rates for the VKA treatment arm were estimated from a variety of RWE studies, and a meta-analysis provided comparative effectiveness for rivaroxaban compared to VKA. Model outcomes included costs (drug costs, clinical event costs, and VKA monitoring costs), quality-adjusted life-years (QALY) and life-years (LY) gained, incremental cost per QALY, and incremental cost per LY. Sensitivity analyses were performed to test the robustness of the model and to better understand the results drivers.

Results

In the base-case analysis, the incremental total cost was €714 and the total incremental QALYs and LYs were 0.12 and 0.16, respectively. The resulting incremental cost/QALY and incremental cost/LY were €6,006 and €4,586, respectively. The results were more sensitive to the inclusion of treatment-specific utility decrements and clinical event rates.

Conclusions

Although there is no official willingness-to-pay threshold in France, these results suggest that rivaroxaban is likely to be cost-effective compared to VKA in French patients with AF from a national insurance perspective.

Klíčová slova:

Atrial fibrillation – Cardiac rehabilitation – Cost-effectiveness analysis – France – Ischemic stroke – Metaanalysis – Myocardial infarction – Vitamin K


Zdroje

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