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Sökning: onr:"swepub:oai:DiVA.org:uu-326359" > Economic Analysis o...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00006119naa a2200469 4500
001oai:DiVA.org:uu-326359
003SwePub
008170711s2017 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3263592 URI
0247 a https://doi.org/10.1001/jamacardio.2017.00652 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Cowper, Patricia A.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
2451 0a Economic Analysis of Apixaban Therapy for Patients With Atrial Fibrillation From a US Perspective :b Results From the ARISTOTLE Randomized Clinical Trial
264 1b American Medical Association (AMA),c 2017
338 a print2 rdacarrier
520 a IMPORTANCE The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban therapy was superior to warfarin therapy in preventing stroke and all-cause death while causing significantly fewer major bleeds. To establish the value proposition of substituting apixiban therapy for warfarin therapy in patients with atrial fibrillation, we performed a cost-effectiveness analysis using patient-level data from the ARISTOTLE trial.OBJECTIVE To assess the cost and cost-effectiveness of apixaban therapy compared with warfarin therapy in patients with atrial fibrillation from the perspective of the US health care system.DESIGN, SETTING, AND PARTICIPANTS This economic analysis uses patient-level resource use and clinical data collected in the ARISTOTLE trial, a multinational randomized clinical trial that observed 18 201 patients (3417 US patients) for a median of 1.8 years between 2006 and 2011.INTERVENTIONS Apixaban therapy vs warfarin therapy.MAIN OUTCOMES AND MEASURES Within-trial resource use and costwere compared between treatments, using externally derived US cost weights. Life expectancies for US patients were estimated according to their baseline risk and treatment using time-based and age-based survival models developed using the overall ARISTOTLE population. Quality-of-life adjustment factors were obtained from external sources. Cost-effectiveness (incremental cost per quality-adjusted life-year gained) was evaluated from a US perspective, and extensive sensitivity analyses were performed.RESULTS Of the 3417 US patients enrolled in ARISTOTLE, the mean (SD) age was 71 (10) years; 2329 (68.2%) were male and 3264 (95.5%) were white. After 2 years of anticoagulation therapy, health care costs (excluding the study drug) of patients treated with apixaban therapy and warfarin therapy were not statistically different (difference, -$ 60; 95% CI, -$ 2728 to $ 2608). Life expectancy, modeled from ARISTOTLE outcomes, was significantly longer with apixaban therapy vs warfarin therapy (7.94 vs 7.54 quality-adjusted life years). The incremental cost, including cost of anticoagulant and monitoring, of achieving these benefits was within accepted US norms ($ 53 925 per quality-adjusted life year, with 98% likelihood of meeting a $ 100 000 willingness-to-pay threshold). Results were generally consistent when model assumptions were varied, with lifetime cost-effectiveness most affected by the price of apixaban and the time horizon.CONCLUSIONS AND RELEVANCE Apixaban therapy for ARISTOTLE-eligible patients with atrial fibrillation provides clinical benefits at an incremental cost that represents reasonable value for money judged using US benchmarks for cost-effectiveness.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
7001 a Sheng, Shubinu Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Lopes, Renato D.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Anstrom, Kevin J.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Stafford, Judith A.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Davidson-Ray, Lindau Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Al-Khatib, Sana M.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Ansell, Jacku Hofstra Northwell Sch Med, Dept Med, Hemstead, NY USA.4 aut
7001 a Dorian, Paulu Univ Toronto, Div Cardiol, Toronto, ON, Canada.4 aut
7001 a Husted, Steenu Aarhus Univ, Aarhus, Denmark.4 aut
7001 a McMurray, John J. V.u Univ Glasgow, British Heart Fdn, Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.4 aut
7001 a Steg, P. Gabrielu Univ Paris Diderot, Dept Hosp Univ Fibrosis Inflammat Remodeling, AP HP, Sorbonne Paris Cite,French Alliance Cardiovasc Cl, Paris, France.;Univ Paris Diderot, Sorbonne Paris Cite, INSERM, U 1148, Paris, France.;Imperial Coll, Royal Brompton Hosp, Natl Heart & Lung Inst, London, England.4 aut
7001 a Alexander, John H.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Wallentin, Lars,d 1943-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)4 aut0 (Swepub:uu)larswall
7001 a Granger, Christopher B.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7001 a Mark, Daniel B.u Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.4 aut
7102 a Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.b Hofstra Northwell Sch Med, Dept Med, Hemstead, NY USA.4 org
7730 t JAMA cardiologyd : American Medical Association (AMA)g 2:5, s. 525-534q 2:5<525-534x 2380-6583x 2380-6591
8564 u https://europepmc.org/articles/pmc5814979
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326359
8564 8u https://doi.org/10.1001/jamacardio.2017.0065

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