Cost-effectiveness analysis of apixaban versus vitamin K antagonists for antithrombotic therapy in patients with atrial fibrillation after acute coronary syndrome or percutaneous coronary intervention in Spain

PLoS One. 2021 Nov 12;16(11):e0259251. doi: 10.1371/journal.pone.0259251. eCollection 2021.

Abstract

Background/objective: AUGUSTUS trial demonstrated that, for patients with atrial fibrillation (AF) having acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI), an antithrombotic regimen with apixaban and P2Y12 resulted in less bleeding, fewer hospitalizations, and similar ischemic events than regimens including a vitamin K antagonist (VKA), aspirin, or both. This study objective was to evaluate long-term health and economic outcomes and the cost-effectiveness of apixaban over VKA, as a treatment option for patients with AF having ACS/PCI.

Methods: A lifetime Markov cohort model was developed comparing apixaban versus VKA across multiple treatment strategies (triple [with P2Y12 + aspirin] or dual [with P2Y12] therapy followed by monotherapy [apixaban or VKA]; triple followed by dual and then monotherapy; dual followed by monotherapy). The model adopted the Spanish healthcare perspective, with a 3-month cycle length and costs and health outcomes discounted at 3%.

Results: Treatment with apixaban resulted in total cost savings of €883 and higher life years (LYs) and quality-adjusted LYs (QALYs) per patient than VKA (net difference, LYs: 0.13; QALYs: 0.11). Bleeding and ischemic events (per 100 patients) were lower with apixaban than VKA (net difference, -13.9 and -1.8, respectively). Incremental net monetary benefit for apixaban was €3,041, using a willingness-to-pay threshold of €20,000 per QALY. In probabilistic sensitivity analysis, apixaban was dominant in the majority of simulations (92.6%), providing additional QALYs at lower costs than VKA.

Conclusions: Apixaban was a dominant treatment strategy than VKA from both the Spanish payer's and societal perspectives, regardless of treatment strategy considered.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / pathology
  • Aged
  • Aspirin / economics*
  • Aspirin / therapeutic use
  • Atrial Fibrillation / drug therapy*
  • Cost-Benefit Analysis*
  • Female
  • Fibrinolytic Agents / economics*
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Male
  • Markov Chains
  • Percutaneous Coronary Intervention / adverse effects
  • Pyrazoles / economics*
  • Pyrazoles / therapeutic use
  • Pyridones / economics*
  • Pyridones / therapeutic use
  • Quality-Adjusted Life Years
  • Spain

Substances

  • Fibrinolytic Agents
  • Pyrazoles
  • Pyridones
  • apixaban
  • Aspirin

Grants and funding

This study was funded by BMS/Pfizer Inc. https://www.bms.com/ and https://www.pfizer.com/. BMS provided support in the form of salaries for authors CP, AK, DD. Pfizer Inc. provided support in the form of salaries for authors MDF, MS, and JS. Authors SR, AS, and TK are employees of Evidera, which received funding from BMS/Pfizer Inc., for the conduct of the study. The specific roles of these authors are articulated in the ‘author contributions’ section. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.