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Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal

2015-11-23Journal article Open access
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dc.contributor.authorCosta, J
dc.contributor.authorFiorentino, F
dc.contributor.authorCaldeira, D
dc.contributor.authorInês, M
dc.contributor.authorLopes Pereira, C
dc.contributor.authorPinheiro, L
dc.contributor.authorVaz-Carneiro, A
dc.contributor.authorBorges, M
dc.contributor.authorGouveia, M
dc.date.accessioned2015-12-22T16:23:49Z
dc.date.available2015-12-22T16:23:49Z
dc.date.issued2015-11-23
dc.description.abstractINTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.pt_PT
dc.identifier.citationRev Port Cardiol. 2015; 34 (12): 723-737pt_PT
dc.identifier.doi10.1016/j.repc.2015.07.004pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2356
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectCHLC FARpt_PT
dc.subjectAnticoagulants/therapeutic usept_PT
dc.subjectAtrial Fibrillation/drug therapypt_PT
dc.subjectBenzimidazoles/economicspt_PT
dc.subjectBenzimidazoles/therapeutic usept_PT
dc.subjectCost-Benefit Analysis
dc.subjectDabigatran/economics
dc.subjectDabigatran/therapeutic use
dc.subjectPyrazoles/economics
dc.subjectPortugal
dc.subjectPyrazoles/therapeutic use
dc.subjectPyridones/economics
dc.subjectPyridones/therapeutic use
dc.subjectStroke/drug therapy
dc.subjectWarfarin/therapeutic use
dc.titleCost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugalpt_PT
dc.title.alternativeCusto-Efectividade dos Novos Anticoagulantes Orais na Fibrilhação Auricular em Portugalpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage737pt_PT
oaire.citation.startPage723pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologiapt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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