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Clinical Drug Investigation
Published in: Clinical Drug Investigation 10/2014

01-10-2014 | Original Research Article

Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium

Authors: Thitima Kongnakorn, Tereza Lanitis, Lievens Annemans, Vincent Thijs, Sophie Marbaix

Published in: Clinical Drug Investigation | Issue 10/2014

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Abstract

Background and Objective

Evidence indicates that vitamin K antagonists (VKAs) and oral anticoagulant therapy are under-utilised for stroke prevention in patients with non-valvular atrial fibrillation (AF), and patients who decline or cannot tolerate such treatment are often prescribed aspirin instead. Apixaban has been shown in the AVERROES trial to be superior to aspirin in preventing stroke and systemic embolism without significantly increasing the risk of major bleeding among patients with AF who are unsuitable for VKA therapy. This study estimates the economic implications and potential cost effectiveness of apixaban compared with aspirin in such individuals from the perspective of healthcare payers in Belgium.

Methods

A Markov model was developed to evaluate the clinical and economic impact of apixaban compared with aspirin in patients unsuitable for VKA therapy. The clinical events modelled include ischaemic and haemorrhagic stroke, systemic embolism, intracranial haemorrhage, other major bleeding, clinically relevant non-major bleeding, myocardial infarction, cardiovascular hospitalisation and treatment discontinuations obtained from AVERROES. Outcomes included life-years and quality-adjusted life-years (QALYs) gained, costs and incremental cost-effectiveness ratios (ICERs) over a lifetime.

Results

Apixaban was projected to increase life expectancy and QALYs compared with aspirin, with an associated increase in drug acquisition costs. The estimated ICER was €7,334 per QALY gained with apixaban compared with aspirin.

Conclusions

Apixaban is a cost-effective alternative to aspirin for patients with AF in Belgium who decline or cannot tolerate VKA treatment.
Appendix
Available only for authorised users
Footnotes
1
This cost was set to 0 for patients switching to VKA treatment to avoid double counting with INR monitoring costs.
 
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Metadata
Title
Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium
Authors
Thitima Kongnakorn
Tereza Lanitis
Lievens Annemans
Vincent Thijs
Sophie Marbaix
Publication date
01-10-2014
Publisher
Springer International Publishing
Published in
Clinical Drug Investigation / Issue 10/2014
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.1007/s40261-014-0224-z

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Erratum

Erratum to: Cost Effectiveness of Apixaban Versus Aspirin for Stroke Prevention in Patients with Non-Valvular Atrial Fibrillation in Belgium