Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.

<h4>Objective</h4>To conduct a systematic review of economic models of newer anticoagulants for stroke prevention in atrial fibrillation (SPAF).<h4>Patients and methods</h4>We searched Medline, Embase, NHSEED and HTA databases and the Tuft's Registry from January 1, 2008...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Brendan L Limone, William L Baker, Jeffrey Kluger, Craig I Coleman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/59668994e1e147bdafc6e20c4c0bcf5a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:59668994e1e147bdafc6e20c4c0bcf5a
record_format	dspace
spelling	oai:doaj.org-article:59668994e1e147bdafc6e20c4c0bcf5a2021-11-18T07:48:19ZNovel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.1932-620310.1371/journal.pone.0062183https://doaj.org/article/59668994e1e147bdafc6e20c4c0bcf5a2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23626785/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To conduct a systematic review of economic models of newer anticoagulants for stroke prevention in atrial fibrillation (SPAF).<h4>Patients and methods</h4>We searched Medline, Embase, NHSEED and HTA databases and the Tuft's Registry from January 1, 2008 through October 10, 2012 to identify economic (Markov or discrete event simulation) models of newer agents for SPAF.<h4>Results</h4>Eighteen models were identified. Each was based on a lone randomized trial/new agent, and these trials were clinically and methodologically heterogeneous. Dabigatran 150 mg, 110 mg and sequentially-dosed were assessed in 9, 8, and 9 models, rivaroxaban in 4 and apixaban in 4. Warfarin was a first-line comparator in 94% of models. Models were conducted from United States (44%), European (39%) and Canadian (17%) perspectives. Models typically assumed patients between 65-73 years old at moderate-risk of stroke initiated anticoagulation for/near a lifetime. All models reported cost/quality-adjusted life-year, 22% reported using a societal perspective, but none included indirect costs. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110 mg (n = 4)/150 mg (n = 2); rivaroxaban (n = 1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs vs. warfarin ranged from $3,547-$86,000 for dabigatran 150 mg, $20,713-$150,000 for dabigatran 110 mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. Apixaban was found economically-dominant to aspirin, and dominant or cost-effective ($11,400-$25,059) vs. warfarin. Indirect comparisons from 3 models suggested conflicting comparative cost-effectiveness results.<h4>Conclusions</h4>Cost-effectiveness models frequently found newer anticoagulants cost-effective, but the lack of head-to-head trials and the heterogeneous characteristics of underlying trials and modeling methods make it difficult to determine the most cost-effective agent.Brendan L LimoneWilliam L BakerJeffrey KlugerCraig I ColemanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 4, p e62183 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Brendan L Limone William L Baker Jeffrey Kluger Craig I Coleman Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
description	<h4>Objective</h4>To conduct a systematic review of economic models of newer anticoagulants for stroke prevention in atrial fibrillation (SPAF).<h4>Patients and methods</h4>We searched Medline, Embase, NHSEED and HTA databases and the Tuft's Registry from January 1, 2008 through October 10, 2012 to identify economic (Markov or discrete event simulation) models of newer agents for SPAF.<h4>Results</h4>Eighteen models were identified. Each was based on a lone randomized trial/new agent, and these trials were clinically and methodologically heterogeneous. Dabigatran 150 mg, 110 mg and sequentially-dosed were assessed in 9, 8, and 9 models, rivaroxaban in 4 and apixaban in 4. Warfarin was a first-line comparator in 94% of models. Models were conducted from United States (44%), European (39%) and Canadian (17%) perspectives. Models typically assumed patients between 65-73 years old at moderate-risk of stroke initiated anticoagulation for/near a lifetime. All models reported cost/quality-adjusted life-year, 22% reported using a societal perspective, but none included indirect costs. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110 mg (n = 4)/150 mg (n = 2); rivaroxaban (n = 1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs vs. warfarin ranged from $3,547-$86,000 for dabigatran 150 mg, $20,713-$150,000 for dabigatran 110 mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. Apixaban was found economically-dominant to aspirin, and dominant or cost-effective ($11,400-$25,059) vs. warfarin. Indirect comparisons from 3 models suggested conflicting comparative cost-effectiveness results.<h4>Conclusions</h4>Cost-effectiveness models frequently found newer anticoagulants cost-effective, but the lack of head-to-head trials and the heterogeneous characteristics of underlying trials and modeling methods make it difficult to determine the most cost-effective agent.
format	article
author	Brendan L Limone William L Baker Jeffrey Kluger Craig I Coleman
author_facet	Brendan L Limone William L Baker Jeffrey Kluger Craig I Coleman
author_sort	Brendan L Limone
title	Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
title_short	Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
title_full	Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
title_fullStr	Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
title_full_unstemmed	Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
title_sort	novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/59668994e1e147bdafc6e20c4c0bcf5a
work_keys_str_mv	AT brendanllimone novelanticoagulantsforstrokepreventioninatrialfibrillationasystematicreviewofcosteffectivenessmodels AT williamlbaker novelanticoagulantsforstrokepreventioninatrialfibrillationasystematicreviewofcosteffectivenessmodels AT jeffreykluger novelanticoagulantsforstrokepreventioninatrialfibrillationasystematicreviewofcosteffectivenessmodels AT craigicoleman novelanticoagulantsforstrokepreventioninatrialfibrillationasystematicreviewofcosteffectivenessmodels
_version_	1718422911848546304

Novel anticoagulants for stroke prevention in atrial fibrillation: a systematic review of cost-effectiveness models.

Ejemplares similares