Publicação
Influence of country-specific data on the results of cost-effectiveness analysis of novel oral anticoagulants in atrial fibrillation
| Resumo: | Background From 2008 on, Novel Oral Anticoagulants are available on the European market. These offer an alternative to Warfarin in stroke prophylaxis in patients with atrial fibrillation. They present the advantage that they don’t need regular monitoring and have less interaction with both other medicines and food. The aim of this study is to understand which of the Novel Oral anticoagulant drug is more cost-effective in 5 different European countries, as well as understand which variables have more impact in the differences between the overall result of cost-effectiveness in these 5 settings. Methods An adaptation of a Markov decision model based on one from the article: “Cost Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Depending on the Quality of Warfarin Anticoagulation Control” by Andrej Janžič and Mitja Kos (2014), was made. This allowed to answer the questions raised and mentioned before by performing the analyses for the 4 drugs (Warfarin, Apixaban, Dabigatran and Rivaroxaban) on the 5 countries (Slovenia, Portugal, Sweden, The Netherlands and the United Kingdom) under the same model. Six types of simulations were run having the Slovenian parameters has reference: 1 – Changing only the drug costs to the ones from each country; 2 – changing all the costs for the national-specific ones (event costs + drug costs); 3 – using only the national-specific life tables; 4 – using only the national-specific utilities and monthly disutilities; 5 – using all national-specific data except the life tables; 5 -using all the national-specific data. The cost-effectiveness analysis, more specifically the cost-utility analysis were made from each State’s healthcare payer perspective. Results Through Incremental Cost-effectiveness Ratio it was possible to conclude that Apixaban was the most cost-effective of the Novel Oral Anticoagulants in Slovenia, Portugal and The Netherlands while Dabigatran proved to be more cost-effective in the United Kingdom. It was also shown that event cost had relatively more impact that drug costs in the overall cost-effectiveness result for each country than drug costs. Life tables also had a great impact in the effectiveness outcome of each country. Countries with lower death probabilities in individuals from 79- to 85 years-old had higher effectiveness outcomes. Conclusion The Cost per Quality-adjusted Life Year varies highly between different European healthcare settings and mostly because of event costs and mortality tables. Also all of the Novel Oral Anticoagulant Drugs Incremental Cost-effectiveness Ratio were under the common reimbursement threshold of 20000€ per Quality-adjusted Life Year except for Rivaroxaban. |
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| Autores principais: | Teixeira, Miguel Arcanjo Resende Martins de |
| Assunto: | Cost-effectiveness Anticoagulants Qaulity-adjusted life years Atrial fibrillation Incremental cost-efectiveness ratio Mestrado Integrado - 2017 |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background From 2008 on, Novel Oral Anticoagulants are available on the European market. These offer an alternative to Warfarin in stroke prophylaxis in patients with atrial fibrillation. They present the advantage that they don’t need regular monitoring and have less interaction with both other medicines and food. The aim of this study is to understand which of the Novel Oral anticoagulant drug is more cost-effective in 5 different European countries, as well as understand which variables have more impact in the differences between the overall result of cost-effectiveness in these 5 settings. Methods An adaptation of a Markov decision model based on one from the article: “Cost Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Depending on the Quality of Warfarin Anticoagulation Control” by Andrej Janžič and Mitja Kos (2014), was made. This allowed to answer the questions raised and mentioned before by performing the analyses for the 4 drugs (Warfarin, Apixaban, Dabigatran and Rivaroxaban) on the 5 countries (Slovenia, Portugal, Sweden, The Netherlands and the United Kingdom) under the same model. Six types of simulations were run having the Slovenian parameters has reference: 1 – Changing only the drug costs to the ones from each country; 2 – changing all the costs for the national-specific ones (event costs + drug costs); 3 – using only the national-specific life tables; 4 – using only the national-specific utilities and monthly disutilities; 5 – using all national-specific data except the life tables; 5 -using all the national-specific data. The cost-effectiveness analysis, more specifically the cost-utility analysis were made from each State’s healthcare payer perspective. Results Through Incremental Cost-effectiveness Ratio it was possible to conclude that Apixaban was the most cost-effective of the Novel Oral Anticoagulants in Slovenia, Portugal and The Netherlands while Dabigatran proved to be more cost-effective in the United Kingdom. It was also shown that event cost had relatively more impact that drug costs in the overall cost-effectiveness result for each country than drug costs. Life tables also had a great impact in the effectiveness outcome of each country. Countries with lower death probabilities in individuals from 79- to 85 years-old had higher effectiveness outcomes. Conclusion The Cost per Quality-adjusted Life Year varies highly between different European healthcare settings and mostly because of event costs and mortality tables. Also all of the Novel Oral Anticoagulant Drugs Incremental Cost-effectiveness Ratio were under the common reimbursement threshold of 20000€ per Quality-adjusted Life Year except for Rivaroxaban. |
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