title: Cost-effectiveness of anticoagulation in patients with nonvalvular atrial fibrillation with edoxaban compared to warfarin in Germany.
abstract: We compared the cost-utility analysis for edoxaban at both doses with that of dabigatran at both doses, rivaroxaban, and apixaban (non vitamin K antagonist oral anticoagulants, NOAC) in a German population. Data of clinical outcome events were taken from edoxaban's ENGAGE-AF, dabigatran's RE-LY, rivaroxaban's ROCKET, and apixaban's ARISTOTLE trials. The base-case analyses of a 65-year-old person with a CHADS2 score >1 gained 0.17 and 0.21 quality-adjusted life years over warfarin for 30 mg od and 60 mg od edoxaban, respectively. The incremental cost-effectiveness ratio was 50.000 and 68.000 euro per quality-adjusted life years for the higher and lower dose of edoxaban (Monte Carlo simulation). These findings were also similar to those for apixaban and more cost-effective than the other NOAC regimens. The current market costs for direct oral anticoagulants are high in relation to the quality of life gained from a German public health care insurance perspective. The willingness-to-pay threshold was lowest for 60 mg edoxaban compared to all direct oral anticoagulants and for 30 mg edoxaban compared to dabigatran and rivaroxaban.
authors: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstraße 14, 68169 Mannheim, Germany.
authors: Martin
authors: M
authors: Krejczy
authors: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstraße 14, 68169 Mannheim, Germany.
authors: Job
authors: J
authors: Harenberg
authors: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Maybachstraße 14, 68169 Mannheim, Germany.
authors: Martin
authors: M
authors: Wehling
authors: Mannheim Institute of Public Health, Medical Faculty Mannheim, Ludolf-Krehl Straße, 68167 Mannheim, Germany.
authors: Konrad
authors: 0000-0002-0687-5014
authors: K
authors: Obermann
authors: Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham B187QH, UK.
authors: Gregory Y H
authors: GY
authors: Lip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects; D003362:Cost-Benefit Analysis / Q000379:methods; D000069604:Dabigatran / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; C552171:edoxaban