Cost-Effectiveness of Edoxaban vs. Warfarin in Patients with Atrial Fibrillation Based on Results of the ENGAGE AF - TIMI 48 Trial: Taiwanese Perspective
Journal
Value in Health Regional Issues
Journal Volume
12
Pages
74-83
Date Issued
2017
Author(s)
Abstract
Background Novel anticoagulants, such as factor Xa inhibitors, have entered clinical practice as alternatives to warfarin for the prevention of stroke and systemic embolic event (SEE) in patients with atrial fibrillation (AF). It is not known whether edoxaban, the fourth-to-market factor Xa inhibitor approved for this indication, will be cost-effective in Taiwan, where the cost of warfarin monitoring is prohibitive. Methods A Markov model projecting lifetime results of edoxaban 60 mg/30 mg dose-reduced versus warfarin in patients with nonvalvular AF, based on the ENGAGE AF – TIMI 48 trial, found edoxaban to be of high value relative to warfarin, from the perspective of the US health care system. We applied Taiwan-specific cost inputs to this model structure to assess the relative cost-effectiveness of edoxaban versus warfarin from the perspective of the Taiwanese health care system. Event rates and hazard ratios from the ENGAGE AF – TIMI 48 East Asian subpopulation were explored in sensitivity analyses. Results Edoxaban was found to be highly cost-effective compared with warfarin, based on guidelines proposed by the World Health Organization (WHO), with a base case incremental cost-effectiveness ratio of $12,902 per quality-adjusted life year gained. These results were robust to variation of key model parameters, including assumptions regarding the cost and quality-of-life impact of stroke and bleeding events, and assuming East Asian-specific (as opposed to full-trial-population) rates for combinations of ischemic stroke, SEE, and major bleeding. Conclusions Despite its higher acquisition cost, edoxaban is an economically attractive alternative to warfarin for the prevention of stroke and SEE in patients with AF in Taiwan. ? 2017
Subjects
atrial fibrillation; cost-effectiveness; decision-analytic modeling; edoxaban; factor Xa inhibitors; health economics; Markov model; Taiwan; warfarin
SDGs
Other Subjects
blood clotting factor 10a inhibitor; edoxaban; warfarin; anticoagulant agent; blood clotting factor 10a inhibitor; edoxaban; pyridine derivative; thiazole derivative; warfarin; Article; atrial fibrillation; bleeding; brain ischemia; cerebrovascular accident; cohort analysis; cost effectiveness analysis; drug cost; drug dose reduction; drug monitoring; East Asian; hazard ratio; health care system; health economics; human; Markov chain; priority journal; quality adjusted life year; Taiwan; Taiwanese; United States; world health organization; aged; atrial fibrillation; clinical trial (topic); cost benefit analysis; dose response; economics; female; male; Aged; Anticoagulants; Atrial Fibrillation; Clinical Trials as Topic; Cost-Benefit Analysis; Dose-Response Relationship, Drug; Drug Monitoring; Factor Xa Inhibitors; Female; Humans; Male; Pyridines; Quality-Adjusted Life Years; Taiwan; Thiazoles; Warfarin
Publisher
Elsevier Inc.
Type
journal article