title: Latin American Clinical Epidemiology Network Series - Paper 2: Apixaban was cost-effective vs. acenocoumarol in patients with nonvalvular atrial fibrillation with moderate to severe risk of embolism in Chile.
abstract: OBJECTIVE
  Nonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost-utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system.
  
  
  METHODS
  We assessed cost-utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature.
  
  
  RESULTS
  Incremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol.
  
  
  CONCLUSIONS
  The use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Universitat Autònoma de Barcelona, Spain. Electronic address: lanastomas@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lanas
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Hospital Hernán Herminda Martin, Chillán, Chile.
authors.forename: Constanza
authors.initials: C
authors.lastname: Castro
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vallejos
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Departamento de Salud Pública, Universidad La Frontera.
authors.forename: Luis
authors.initials: L
authors.lastname: Bustos
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile.
authors.forename: Catherine
authors.initials: C
authors.lastname: de La Puente
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile.
authors.forename: Monica
authors.initials: M
authors.lastname: Velasquez
authors.affiliation: Centro de Excelencia CIGES, Universidad La Frontera, Montt 112, Temuco, Chile; Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad La Frontera, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zaror
mesh_terms: D000074:Acenocoumarol / Q000191:economics* / Q000627:therapeutic use*; D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D002677:Chile; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D016021:Epidemiologic Studies; D065427:Factor Xa Inhibitors / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007843:Latin America; D008297:Male; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use*; D012306:Risk; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000074:Acenocoumarol
keywords: Acenocoumarol; Apixaban; Atrial fibrillation; Cost-effectiveness; Cost–utility; Novel anticoagulants