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Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis

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Abstract

Edoxaban, an oral direct factor Xa inhibitor, has been found non-inferior to warfarin for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), with a lower rate of intracranial bleeding. The aim of our investigation was to assess the cost-effectiveness of edoxaban versus warfarin from the perspective of the Italian health-care system. A Markov decision model was used to evaluate lifetime cost and quality-adjusted life expectancy of NVAF patients treated with warfarin or edoxaban. Transition probabilities were obtained from the ENGAGE AF-TIMI 48 trial, cost estimates were based on Italian prices and tariffs, utilities were obtained from the literature. One-way and second-order sensitivity analyses were performed. In the base case, lifetime costs were €18,658 for edoxaban and €14,060 for warfarin. Discounted quality-adjusted survival was 9.022 years for edoxaban and 8.425 years for warfarin, leading to an incremental cost-utility ratio of €7,713 per quality-adjusted life year (QALY) gained. Results were sensitive to time horizon, time in therapeutic range of warfarin and to the relative impact of warfarin versus edoxaban therapy onto quality of life. Probabilistic sensitivity analysis showed edoxaban to be cost-effective versus warfarin in 92.3 % of the simulations at a willingness-to-pay threshold of €25,000 per QALY. In conclusion, edoxaban proved to be a cost-effective alternative to warfarin in patients with moderate-to-high-risk NVAF.

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Acknowledgments

No sources of funding were used to assist in the conduct of this study

Conflict of interest

The authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy

    Carla Rognoni

  2. Hematology Unit, Cardinal Massaia Hospital, Asti, Italy

    Monia Marchetti

  3. Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy

    Silvana Quaglini

  4. Department of Medicine, Azienda Ospedaliera della Provincia di Pavia, Casorate Primo, PV, Italy

    Nicola Lucio Liberato

Authors
  1. Carla Rognoni
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  2. Monia Marchetti
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  3. Silvana Quaglini
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  4. Nicola Lucio Liberato
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Correspondence to Nicola Lucio Liberato.

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Rognoni, C., Marchetti, M., Quaglini, S. et al. Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis. J Thromb Thrombolysis 39, 149–154 (2015). https://doi.org/10.1007/s11239-014-1104-3

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  • DOI: https://doi.org/10.1007/s11239-014-1104-3

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