title: Economic evaluation of apixaban for the prevention of stroke in non-valvular atrial fibrillation in the Netherlands.
abstract: BACKGROUND
  Stroke prevention is the main goal of treating patients with atrial fibrillation (AF). Vitamin-K antagonists (VKAs) present an effective treatment in stroke prevention, however, the risk of bleeding and the requirement for regular coagulation monitoring are limiting their use. Apixaban is a novel oral anticoagulant associated with significantly lower hazard rates for stroke, major bleedings and treatment discontinuations, compared to VKAs.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of apixaban compared to VKAs in non-valvular AF patients in the Netherlands.
  
  
  METHODS
  Previously published lifetime Markov model using efficacy data from the ARISTOTLE and the AVERROES trial was modified to reflect the use of oral anticoagulants in the Netherlands. Dutch specific costs, baseline population stroke risk and coagulation monitoring levels were incorporated. Univariate, probabilistic sensitivity and scenario analyses on the impact of different coagulation monitoring levels were performed on the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Treatment with apixaban compared to VKAs resulted in an ICER of €10,576 per quality adjusted life year (QALY). Those findings correspond with lower number of strokes and bleedings associated with the use of apixaban compared to VKAs. Univariate sensitivity analyses revealed model sensitivity to the absolute stroke risk with apixaban and treatment discontinuations risks with apixaban and VKAs. The probability that apixaban is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 68%. Results of the scenario analyses on the impact of different coagulation monitoring levels were quite robust.
  
  
  CONCLUSIONS
  In patients with non-valvular AF, apixaban is likely to be a cost-effective alternative to VKAs in the Netherlands.
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Jelena
authors.initials: J
authors.lastname: Stevanović
authors.affiliation: Bristol-Myers Squibb, Woerden, the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Pompen
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Hoa H
authors.initials: HH
authors.lastname: Le
authors.affiliation: Pfizer Nederland, Capelle aan den IJssel, the Netherlands.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Rozenbaum
authors.affiliation: Martini Hospital, Groningen, the Netherlands.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Tieleman
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D015110:4-Hydroxycoumarins / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007192:Indenes / Q000191:economics / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use*; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000191:economics / Q000627:therapeutic use
chemical_list: D015110:4-Hydroxycoumarins; D005343:Fibrinolytic Agents; D007192:Indenes; D011720:Pyrazoles; D011728:Pyridones; C011664:antivitamins K; D014812:Vitamin K; C522181:apixaban
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