Integrating Real-World Evidence in Economic Evaluation of Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation in a Developing Country

被引:0
作者
Syeed, M. Sakil [1 ]
Nonthasawadsri, Teerawat [1 ]
Nelson, Richard E. E. [2 ,3 ]
Chaiyakunapruk, Nathorn [1 ,3 ]
Nathisuwan, Surakit [4 ]
机构
[1] Univ Utah, Coll Pharm, Dept Pharmacotherapy, Salt Lake City, UT USA
[2] Univ Utah, Sch Med, Div Epidemiol, Salt Lake City, UT USA
[3] Vet Affairs Salt Lake City Healthcare Syst, Informat Decis Enhancement & Analyt Sci IDEAS Ctr, Salt Lake City, UT USA
[4] Mahidol Univ, Fac Pharm, Dept Pharm, Clin Pharm Div, 447 Sri Ayutthaya Rd, Bangkok 10400, Thailand
关键词
COST-EFFECTIVENESS; WARFARIN; THERAPY; MANAGEMENT; QUALITY; SOCIETY;
D O I
10.1007/s40256-023-00570-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
ObjectiveThis study aimed to estimate the cost effectiveness of non-vitamin K oral anticoagulants (NOACs) compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) in Thailand where suboptimal anticoagulation control is common.Materials and MethodsA hypothetical cohort of 65-year-old patients with NVAF and their disease progression was simulated in the Markov model. The following anticoagulant agents were used: warfarin, dabigatran, rivaroxaban, and apixaban. Warfarin with high, intermediate, and low time in therapeutic ranges (TTR) was used as the three different reference treatments. Baseline clinical events were obtained from a recently published real-world study in Thailand. A lifetime horizon was utilized in this model, and all analyses were performed from societal and healthcare perspectives. The results were reported as incremental cost-effectiveness ratios (ICERs) in 2021 US dollars per quality-adjusted life-year (QALY) gained. The sensitivity analyses were performed to assess the influence of parameter uncertainty.ResultsApixaban was a cost-effective intervention compared with warfarin with low and intermediate TTR groups. In the low TTR group, the ICERs were $779 and $816 per QALY gained from the societal and healthcare perspectives, respectively, and in the intermediate TTR group, the ICERs were $2038 and $3159 per QALY gained from the societal and healthcare perspectives, respectively. Both ICERs were below the accepted willingness-to-pay threshold ($4806) in the context of Thailand's healthcare.ConclusionsIn a developing country where suboptimal anticoagulation control is common, apixaban was the cost-effective alternative to warfarin for patients with both low and intermediate TTR control.
引用
收藏
页码:173 / 183
页数:11
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