Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain

Escobar Cervantes, Carlos; Martí Almor, Julio; Pérez Cabeza, Alejandro Isidoro; Bowrin, Kevin; Llorac Moix, Aleix; Genís Gironès, Mar; Gasche, David; Aurélie, Millier; Tardu, Jean; Toumi, Mondher; Briere, Jean-Baptiste

doi:http://dx.doi.org/10.1371/journal.pone.0266658

Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain

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Escobar Cervantes C, Martí-Almor J, Cabeza AIP, Bowrin K, Llorac Moix A, Genís Gironès M, et al. Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain. PLoS One. 2022 Apr 20; 17(4): e0266658. DOI: 10.1371/journal.pone.0266658

Abstract

Aims: a Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. Methods: all inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. Results: when compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. Conclusion: these results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.