Cost Effectiveness of Treatments for Stroke Prevention in Atrial Fibrillation: Focus on the Novel Oral Anticoagulants
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REVIEW ARTICLE
Cost Effectiveness of Treatments for Stroke Prevention in Atrial Fibrillation: Focus on the Novel Oral Anticoagulants Charalampos Kasmeridis • Stavros Apostolakis • Lars Ehlers • Lars H. Rasmussen • Giuseppe Boriani Gregory Y. H. Lip
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Published online: 2 October 2013 Springer International Publishing Switzerland 2013
Abstract For more than 5 decades, the only available treatment for the prevention of atrial fibrillation (AF)related stroke were the vitamin K antagonists. Recently, novel oral anticoagulants (NOAC) have been approved for the prevention of AF-related stroke. In the present article, the cost effectiveness of AF-related stroke-prevention strategies is reviewed. The emphasis on NOACs aims to provide an overview of their impact on health economics based on the published cost-effectiveness analyses. The available evidence suggests that the balance from the efficacy and safety point of view makes the treatment with the NOACs a cost-effective alternative to warfarin. Thus, the NOACs offer efficacy, safety and convenience, as well as cost effectiveness, for stroke prevention in AF.
Key Points for Decision Makers • The majority of health economic analyses suggest that the novel oral anticoagulants are cost effective compared with warfarin for stroke prevention in atrial fibrillation. • Cost effectiveness mainly depends upon the price of the new drug and the efficacy of local anticoagulation services. • These analyses are based on clinical trial efficacy and safety data and their outcomes should be interpreted with some caution.
1 Introduction
C. Kasmeridis and S. Apostolakis are joint first authors. C. Kasmeridis S. Apostolakis G. Y. H. Lip (&) University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK e-mail: [email protected] L. Ehlers Danish Center for Healthcare Improvements (DCHI), Department of Business & Management, Faculties of Health Science and Social Science, University of Aalborg, Fibigerstraede 11, 9200 Aalborg, Denmark e-mail: [email protected] L. H. Rasmussen Department of Clinical Medicine, Faculties of Health Science and Social Science, Danish Center for Healthcare Improvements, University of Aalborg, Aalborg, Denmark G. Boriani Institute of Cardiology, University of Bolognia, Bologna, Italy
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and becomes more prevalent with increasing age. Patients with AF have a five times higher risk for thromboembolism (stroke and non-central nervous system systemic embolism) than age-matched individuals in sinus rhythm [1–3]. Until recently, vitamin K antagonists (VKAs) were the only oral anticoagulants used to reduce the risk of thromboembolic complications in AF, though with multiple limitations [4]. More recently, novel oral anticoagulants (NOACs) have emerged in clinical practice: the oral direct thrombin inhibitor dabigatran and the oral direct factor Xa inhibitors rivaroxaban and apixaban [5]. Three large landmark clinical trials, namely RE-LY (Randomized Eva
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