Cost-Effectiveness of Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation in Hong Kong

Abstract

<h3>Objectives</h3><p>The emergence of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/direct-oral-anticoagulant" title="Learn more about direct oral anticoagulants from ScienceDirect's AI-generated Topic Pages">direct oral anticoagulants</a> (DOACs) has revolutionized the prevention of stroke related to nonvalvular atrial fibrillation (NVAF). Several DOACs are available on the market, while the cost-effectiveness comparison among DOACs and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/vitamin-k-antagonist" title="Learn more about vitamin K antagonist from ScienceDirect's AI-generated Topic Pages">vitamin K antagonist</a>(warfarin) in NVAF management in Hong Kong market remains scarce. The objective of this study was to assess the cost-effectiveness of DOACs and warfarin from a Hong Kong public institutional perspective to inform formulary listing decisions.</p><h3>Methods</h3><p>A previously developed Markov model was adapted to simulate the lifetime <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/disease-exacerbation" title="Learn more about disease progression from ScienceDirect's AI-generated Topic Pages">disease progression</a> of a hypothetical cohort of 1000 patients. Net monetary costs, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio were computed for the following competing alternatives: warfarin, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/apixaban" title="Learn more about apixaban from ScienceDirect's AI-generated Topic Pages">apixaban</a> (5 mg twice daily), <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/dabigatran" title="Learn more about dabigatran from ScienceDirect's AI-generated Topic Pages">dabigatran</a> (110 mg or 150 mg twice daily), and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/rivaroxaban" title="Learn more about rivaroxaban from ScienceDirect's AI-generated Topic Pages">rivaroxaban</a> (20 mg once daily). Probabilistic sensitivity analyses were conducted to address study uncertainties.</p><h3>Results</h3><p>In base-case results, all DOACs were associated with greater QALYs improvements and lower costs than warfarin. Rivaroxaban, apixaban, dabigatran 150 mg, dabigatran 110 mg, and warfarin resulted in net costs US dollar (USD) 8088, USD 8240, USD 8566, USD 8653, and USD 16 363 and net QALY 5.87, 6.017, 6.022, 5.98, and 5.829, respectively. In probabilistic sensitivity analysis, the probabilities of warfarin, rivaroxaban 20 mg, dabigatran 110 mg, dabigatran 150 mg, and apixaban 5 mg being cost-effective of 2000 iterations were 0%, 0%, 29.4%, 33.2%, and 37.4%, respectively.</p><h3>Conclusion</h3><p>Apixaban was the most cost-effective option compared with other DOACs and warfarin in the management of NVAF; this conclusion is consistent under all the tested uncertainty scenarios.</p>