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Economic Analysis o...
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Cowper, Patricia A.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
(author)
Economic Analysis of Apixaban Therapy for Patients With Atrial Fibrillation From a US Perspective : Results From the ARISTOTLE Randomized Clinical Trial
- Article/chapterEnglish2017
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American Medical Association (AMA),2017
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LIBRIS-ID:oai:DiVA.org:uu-326359
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326359URI
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https://doi.org/10.1001/jamacardio.2017.0065DOI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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.
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Sheng, ShubinDuke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Lopes, Renato D.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Anstrom, Kevin J.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Stafford, Judith A.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Davidson-Ray, LindaDuke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Al-Khatib, Sana M.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Ansell, JackHofstra Northwell Sch Med, Dept Med, Hemstead, NY USA.
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Dorian, PaulUniv Toronto, Div Cardiol, Toronto, ON, Canada.
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Husted, SteenAarhus Univ, Aarhus, Denmark.
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McMurray, John J. V.Univ Glasgow, British Heart Fdn, Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.
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Steg, P. GabrielUniv 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.
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Alexander, John H.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Wallentin, Lars,1943-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall
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Granger, Christopher B.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Mark, Daniel B.Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.
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Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA.Hofstra Northwell Sch Med, Dept Med, Hemstead, NY USA.
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In:JAMA cardiology: American Medical Association (AMA)2:5, s. 525-5342380-65832380-6591
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