Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis.
J Thromb Thrombolysis
; 39(2): 149-54, 2015 Feb.
Article
em En
| MEDLINE
| ID: mdl-24973057
ABSTRACT
Edoxaban, an oral direct factor Xa inhibitor, has been found non-inferior to warfarin for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), with a lower rate of intracranial bleeding. The aim of our investigation was to assess the cost-effectiveness of edoxaban versus warfarin from the perspective of the Italian health-care system. A Markov decision model was used to evaluate lifetime cost and quality-adjusted life expectancy of NVAF patients treated with warfarin or edoxaban. Transition probabilities were obtained from the ENGAGE AF-TIMI 48 trial, cost estimates were based on Italian prices and tariffs, utilities were obtained from the literature. One-way and second-order sensitivity analyses were performed. In the base case, lifetime costs were 18,658 for edoxaban and 14,060 for warfarin. Discounted quality-adjusted survival was 9.022 years for edoxaban and 8.425 years for warfarin, leading to an incremental cost-utility ratio of 7,713 per quality-adjusted life year (QALY) gained. Results were sensitive to time horizon, time in therapeutic range of warfarin and to the relative impact of warfarin versus edoxaban therapy onto quality of life. Probabilistic sensitivity analysis showed edoxaban to be cost-effective versus warfarin in 92.3 % of the simulations at a willingness-to-pay threshold of 25,000 per QALY. In conclusion, edoxaban proved to be a cost-effective alternative to warfarin in patients with moderate-to-high-risk NVAF.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Piridinas
/
Fibrilação Atrial
/
Tiazóis
/
Varfarina
/
Acidente Vascular Cerebral
/
Hemorragias Intracranianas
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Limite:
Humans
País como assunto:
Europa
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article