Cost-Effectiveness Analysis of Oral Anticoagulants in Stroke Prevention among Patients with Atrial Fibrillation in Taiwan

doi:10.6515/ACS.202001_36(1).20190511A

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Title:	Cost-Effectiveness Analysis of Oral Anticoagulants in Stroke Prevention among Patients with Atrial Fibrillation in Taiwan
Authors:	Liao, Chia-Te Lee, Mei-Chuan Chen, Zhih-Cherng Ku, Li-Jung Elizabeth Wang, Jung-Der Toh, Han Siong
Contributors:	Chi Mei Med Ctr, Dept Cardiol Natl Cheng Kung Univ, Coll Med, Dept Publ Hlth Chi Mei Med Ctr, Dept Pharm Chia Nan Univ Pharm & Sci, Dept Pharm Chi Mei Med Ctr, Dept Intens Care Med Natl Cheng Kung Univ, Inst Clin Med
Keywords:	Anticoagulant therapy Atrial fibrillation Cost-effectiveness analysis
Date:	2020
Issue Date:	2022-11-18 11:24:43 (UTC+8)
Publisher:	Taiwan Soc Cardiology
Abstract:	Background: Non-vitamin K oral antagonist anticoagulants (NOACs) have been widely used in stroke prevention in atrial fibrillation (SPAF). The aim of this study was to compare the pharmacoeconomic impact of oral anticoagulants (OACs) including warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban in SPAF in Taiwan. Methods: A decision tree, Markov model, and multiple sensitivity analyses were used to project the lifetime costs and quality-adjusted life years (QALYs) of OACs. Transitional probabilities were derived from a systematic review and network meta-analysis for Asian populations. Utilities and costs were obtained from published studies and the Taiwan National Health Insurance Research Database. Threshold of the willingness to pay (WTP) at USD 20,000 was applied to evaluate the results. Results: In base-case analysis, warfarin had the lowest cost at $13,363 4,036, and edoxaban 60 mg produced the most QALYs at 11.92 +/- 1.98. The incremental cost-effectiveness ratios of dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg, and edoxaban 60 mg versus warfarin were $6,415, $4,225, $4,115 and $5,458 per QALY gained, respectively. Monte Carlo analysis revealed that dabigatran 150 and 110 mg, rivaroxaban 20 and 15 mg, apixaban 5 mg and edoxaban 60 mg were most cost-effective at 21.9%, 27.1%, 23.6%, and 27.4% of $20,000 compared to warfarin. Conclusions: From a Taiwan national payer perspective, all NOACs are cost-effective substitutes for warfarin in SPAF. However, the likelihood of cost-effective iterations for NOACs is highly driven by their market prices at the time and different WTP thresholds of policymakers.
Relation:	Acta Cardiologica Sinica, v.36, n.1, pp.12
Appears in Collections:	[Dept. of Pharmacy] Periodical Articles

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