Real-world cost-effectiveness of rivaroxaban compared with vitamin K antagonists in the context of stroke prevention in atrial fibrillation in France

Kevin Bowrin, Jean-Baptiste Briere, Laurent Fauchier (), Craig Coleman, Aurélie Millier, Mondher Toumi, Emilie Clay and Pierre Levy
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Laurent Fauchier: Département de Cardiologie [Hôpital de la Timone - APHM] - APHM - Assistance Publique - Hôpitaux de Marseille - TIMONE - Hôpital de la Timone [CHU - APHM], EES - Éducation Éthique Santé EA 7505 - UT - Université de Tours
Aurélie Millier: Creativ-Ceutical France - Creativ-Ceutical
Mondher Toumi: CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie - AMU - Aix Marseille Université
Emilie Clay: Creativ-Ceutical France - Creativ-Ceutical
Pierre Levy: Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique

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Abstract: Objective: The objective was to assess the real-world cost-effectiveness of rivaroxaban, versus vitamin K antagonists (VKAs), for stroke prevention in patients with atrial fibrillation (AF) from a French national health insurance perspective. Methods: A Markov model was developed with a lifetime horizon and cycle length of 3 months. All inputs were drawn from real-world evidence (RWE) studies: data on baseline patient characteristics at model entry were obtained from a French RWE study, clinical event rates as well as persistence rates for the VKA treatment arm were estimated from a variety of RWE studies, and a meta-analysis provided comparative effectiveness for rivaroxaban compared to VKA. Model outcomes included costs (drug costs, clinical event costs, and VKA monitoring costs), quality-adjusted life-years (QALY) and life-years (LY) gained, incremental cost per QALY, and incremental cost per LY. Sensitivity analyses were performed to test the robustness of the model and to better understand the results drivers. Results: In the base-case analysis, the incremental total cost was €714 and the total incremental QALYs and LYs were 0.12 and 0.16, respectively. The resulting incremental cost/QALY and incremental cost/LY were €6,006 and €4,586, respectively. The results were more sensitive to the inclusion of treatment-specific utility decrements and clinical event rates. Conclusions: Although there is no official willingness-to-pay threshold in France, these results suggest that rivaroxaban is likely to be cost-effective compared to VKA in French patients with AF from a national insurance perspective

Date: 2020
Note: View the original document on HAL open archive server: https://hal.science/hal-03655987v1
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Published in PLoS ONE, 2020, 15 (1), pp.e0225301. ⟨10.1371/journal.pone.0225301⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03655987

DOI: 10.1371/journal.pone.0225301

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