title: Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain.
abstract: OBJECTIVE
  Cost-effectiveness analysis of apixaban (5 mg twice daily) vs acenocoumarol (5mg/day) in the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain.
  
  
  METHODS
  Markov model covering the patient's entire lifespan with 10 health states. Data on the efficacy and safety of the drugs were provided by the ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic equivalence.
  
  
  CONCLUSIONS
  The Spanish National Health System and society. Information on the cost of the drugs, complications, and the management of the disease was obtained from Spanish sources.
  
  
  RESULTS
  In a cohort of 1000 patients with nonvalvular atrial fibrillation, administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) and result in more quality-adjusted life years (by 0.194 years) per patient. With apixaban, the incremental costs for the Spanish National Health System and for society would be € 2,488 and € 1,826 per patient, respectively. Consequently, the costs per life year gained would be € 13,305 and € 9,765 and the costs per quality-adjusted life year gained would be € 12,825 and € 9,412 for the Spanish National Health System and for society, respectively. The stability of the baseline case was confirmed by sensitivity analyses.
  
  
  CONCLUSIONS
  According to this analysis, apixaban may be cost-effective in the prevention of stroke in patients with nonvalvular atrial fibrillation compared with acenocoumarol.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barón Esquivias
authors.affiliation: Servicio de Hemoterapia y Hemostasia, Hospital Clínic, Barcelona, Spain.
authors.forename: Ginés
authors.initials: G
authors.lastname: Escolar Albaladejo
authors.affiliation: Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Departamento de Economía de la Salud, Bristol-Myers Squibb España, Madrid, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Betegón Nicolás
authors.affiliation: Departamento de Economía de la Salud, Bristol-Myers Squibb España, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Canal Fontcuberta
authors.affiliation: Departamento de Farmacoeconomía y Resultados en Salud, Pfizer España, Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: de Salas-Cansado
authors.affiliation: Health Value, Madrid, Spain.
authors.forename: Darío
authors.initials: D
authors.lastname: Rubio-Rodríguez
authors.affiliation: Health Value, Madrid, Spain. Electronic address: crubioterres@healthvalue.org.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rubio-Terrés
mesh_terms: D000074:Acenocoumarol; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D018803:Models, Economic; D011720:Pyrazoles / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000074:Acenocoumarol
keywords: Acenocoumarol; Acenocumarol; Apixaban; Apixabán; Cost-effectiveness; Coste-efectividad; Fibrilación auricular no valvular; Nonvalvular atrial fibrillation