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Rev Esp Cardiol (Engl Ed). 2019 May;72(5):398-406. doi: 10.1016/j.rec.2018.03.024. Epub 2018 Jul 7.

Would the Use of Edoxaban Be Cost-effective for the Prevention of Stroke and Systemic Embolism in Patients With Nonvalvular Atrial Fibrillation in Spain?

[Article in English, Spanish]

Author information

1
Servicio de Cardiología, Hospital de Galdakao, Usansolo, Vizcaya, Spain.
2
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain.
3
Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
4
Market Access Department, Daiichi Sankyo Europe GmbH, Munich, Germany.
5
Departamento de Acceso, Daiichi Sankyo España S.A., Madrid, Spain.
6
Oblikue Consulting S.L., Barcelona, Spain. Electronic address: ferran.perez@oblikue.com.

Abstract

INTRODUCTION AND OBJECTIVES:

To assess the cost-effectiveness of edoxaban vs acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain.

METHODS:

Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, haemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources.

RESULTS:

Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was 3916€, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was 11 518€, within the thresholds commonly considered cost-effective in Spain (25 000-30 000 €/QALY). The robustness of the results was confirmed by various sensitivity analyses.

CONCLUSIONS:

Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.

KEYWORDS:

Análisis de coste-efectividad; Cost-effectiveness analysis; Edoxaban; Edoxabán; España; Fibrilación auricular no valvular; Nonvalvular atrial fibrillation; Prevención de embolia sistémica; Prevención de ictus; Spain; Stroke prevention; Systemic embolism prevention

PMID:
31007166
DOI:
10.1016/j.rec.2018.03.024

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