Cost-Effectiveness of Apixaban Compared With Aspirin for Stroke Prevention in Atrial Fibrillation Among Patients Unsuitable for Warfarin.
Circ Cardiovasc Qual Outcomes. 2012 Jun 26;
Authors: Lee S, Anglade MW, Meng J, Hagstrom K, Kluger J, Coleman CI
Abstract
BACKGROUND: score=2 and a lower-risk of bleeding. We used a 1-month cycle-length and ran separate base-case analyses assuming a trial-length (1 year) and a longer-term (10-year) follow-up. Total costs/patient were $3454 and $1805 for apixaban and aspirin in the trial-length and $44 232 and $50 066 in the 10-year model. Corresponding QALYs were 0.96 and 0.96 in the trial-length and 6.87 and 6.51 in the 10-year model, making apixaban inferior in the first model but dominant in the latter. Conclusions were sensitive to baseline stroke rate in both models, and the monthly cost of major stroke, relative risk of stroke, and prior vitamin-K antagonist use in the life-time model. Probabilistic sensitivity analysis suggested apixaban would only be a cost-effective alternative (<$50 000/QALY) to aspirin 11% of the time in the trial-length model, but cost-effective or dominate 96.7% and 87.5% of iterations in the 10-year model.Conclusions-In our trial-length model, apixaban was more costly and less effective than aspirin; however, as follow-up was extended, apixaban became cost-effective and eventually dominant.
PMID: 22740012 [PubMed - as supplied by publisher]