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Cost-Effectiveness of Coronary and Peripheral Artery Disease Antithrombotic Treatments in Finland.
- Source :
-
Advances in therapy [Adv Ther] 2020 Jul; Vol. 37 (7), pp. 3348-3369. Date of Electronic Publication: 2020 Jun 09. - Publication Year :
- 2020
-
Abstract
- Introduction: Currently, 15-20% of individuals with coronary artery disease (chronic coronary syndrome [CCS]) or peripheral artery disease (PAD) receiving routine treatment experience cardiovascular events (CVEs) within 3-4 years. Using PICOSTEPS (Patients-Intervention-Comparators-Outcomes-Setting-Time-Effects-Perspective-Sensitivity analysis) reporting, we evaluated the cost-effectiveness of recently approved rivaroxaban 2.5 mg twice daily in combination with acetylsalicylic acid 100 mg daily (RIV + ASA) for the prevention of CVEs among Finns with CCS or symptomatic PAD.<br />Methods: Myocardial infarction, ischemic stroke, intracranial hemorrhage, acute limb ischemia, amputations, major extracranial bleeding, venous thromboembolism, and cardiovascular deaths were modeled in a Markov model examining a cohort of patients with CCS or symptomatic PAD. Relative effects of the intervention (RIV + ASA) and comparator (ASA) were based on the COMPASS trial. The primary outcome was 3%/year discounted incremental cost-effectiveness ratio (ICER), defined as cost (2019 euros) per quality-adjusted life year (QALY) gained in the Finnish setting over a lifetime horizon. In addition to nonfatal and fatal CVEs, the effects factored Finnish non-CVE mortality, quality of life, and direct costs from a public payer perspective. Disaggregated costs and QALYs, costs per life year gained (LYG), and ischemic strokes avoided, net monetary benefit (NMB), expected value of perfect information (EVPI), economic value-added (EVA), cost-effectiveness table, and acceptability frontier were examined. Probabilistic and deterministic sensitivity analyses were conducted.<br />Results: In the deterministic comparison with ASA over a lifetime horizon, RIV + ASA resulted in a benefit of 0.404 QALYs and 0.474 LYGs for an additional cost of €3241, resulting in an ICER of €8031/QALY. The probabilistic ICER was €4313/QALY (EVPI €1829/patient). RIV + ASA had positive NMB (€8791/patient), low EVPI (€88/patient), high EVA (€8703/patient), and 91% probability of cost-effectiveness using the willingness-to-pay of €25,254/QALY. The primary result was conservative and robust for RIV + ASA.<br />Conclusion: RIV + ASA was a cost-effective treatment alternative compared with ASA in patients with CCS or symptomatic PAD in Finland.
- Subjects :
- Adult
Aged
Aged, 80 and over
Coronary Artery Disease epidemiology
Cost-Benefit Analysis
Factor Xa Inhibitors therapeutic use
Female
Finland epidemiology
Humans
Male
Middle Aged
Peripheral Arterial Disease epidemiology
Rivaroxaban therapeutic use
Coronary Artery Disease drug therapy
Coronary Artery Disease economics
Factor Xa Inhibitors economics
Fibrinolytic Agents economics
Fibrinolytic Agents therapeutic use
Peripheral Arterial Disease drug therapy
Rivaroxaban economics
Subjects
Details
- Language :
- English
- ISSN :
- 1865-8652
- Volume :
- 37
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Advances in therapy
- Publication Type :
- Academic Journal
- Accession number :
- 32519113
- Full Text :
- https://doi.org/10.1007/s12325-020-01398-8