title: A Systematic Literature Review on the Cost-Effectiveness of Apixaban for Stroke Prevention in Non-valvular Atrial Fibrillation.
abstract: BACKGROUND
  Economic evaluations are becoming increasingly important due to limitations in economic resources, the expense of many new treatments, the need to allocate health spending as effectively as possible, and the need to inform decision makers. Based on the data from the apixaban studies (ARISTOTLE and AVERROES), several economic evaluations have been performed in various countries to demonstrate the efficacy of apixaban versus warfarin and aspirin or other new oral anticoagulants (NOACs) for preventing stroke in patients with non-valvular atrial fibrillation (NVAF).The aim of this study was to perform a systematic literature review of published economic evaluations with apixaban in the indication of stroke prevention in patients with NVAF.
  
  
  METHODS
  A search in PubMed, Cochrane Library, Google Scholar, and Index Medicus Español was conducted in June 2015. Inclusion and exclusion criteria were established. The main characteristics were recorded for all relevant articles after being reviewed. In addition, a weighted version of the Drummond's checklist was used to further assess the quality of the selected studies.
  
  
  RESULTS
  After review, 26 cost-effectiveness analyses through Markov models were included; the identified economic evaluations represent different willingness-to-pay (WTP) thresholds, discount rates, medical costs, and healthcare systems. Apixaban was compared with warfarin/acenocoumarol in 7 of them (27%), with warfarin/NOACs in 14 (54%), with aspirin in 2 (8%), and with warfarin/aspirin in 3 (11%). Models were conducted from Europe (69%), USA (23%), Australia (4%), and Latin America (4%). All models reported cost/quality-adjusted life years (QALYs) gained, 92% reported using a payer perspective, and 8% using a societal perspective; the median quality score of the selected studies was 89 (out of 119), with a range of 55-103. In models performed in Europe, incremental cost-effectiveness ratios (ICERs) of apixaban versus warfarin ranged from €5607/QALY to €57,245/QALY, while ICERs versus aspirin ranged from being dominant to €7334/QALY. In models carried out in the USA, ICERs of apixaban versus warfarin ranged from being dominant to $93,063/QALY.
  
  
  CONCLUSIONS
  Different cost-effectiveness analyses suggest that apixaban is a cost-effective therapeutic option according to the WTP thresholds used in countries where cost-effectiveness analyses, were performed.
  
  
  BACKGROUND
  BMS and Pfizer.
authors.affiliation: INNOVA Strategic Consulting, Barcelona, Spain. cpinyol@innovaheor.com.
authors.forename: Carme
authors.identifier: http://orcid.org/0000-0002-1532-0782
authors.initials: C
authors.lastname: Pinyol
authors.affiliation: Internal Medicine Department, Hospital Comarcal Vega Baja, Orihuela, Alicante, Spain.
authors.forename: Jose Mª
authors.initials: JM
authors.lastname: Cepeda
authors.affiliation: Cardiology Department, Hospital La Paz, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Roldan
authors.affiliation: Hematology Department, Hospital Morales Meseguer, Murcia, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Roldan
authors.affiliation: Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Jimenez
authors.affiliation: Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gonzalez
authors.affiliation: Health Economics and Outcomes Research, Pfizer S.L.U., Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Soto
keywords: Apixaban; Economic evaluation; Non-valvular atrial fibrillation; Systematic literature review