Cost-effectiveness of apixaban vs aspirin for the reduction of thrombo-embolism in high-risk patients with device-detected atrial fibrillation: insights from the ARTESiA trial
Notice bibliographique
Résumé
Abstract Background The Apixaban for the Reduction of Thrombo-Embolism in Patients with Subclinical Atrial Fibrillation (ARTESiA) trial demonstrated that apixaban, compared to aspirin, prevented stroke or systemic embolism, with the largest effect among patients with a CHA₂DS₂-VASc score >4. We hypothesize that apixaban in patients with a CHA₂DS₂-VASc score >4 will be cost-effective due to cost savings from stroke prevention. Methods Using healthcare perspectives specific to Canada, the UK, Germany and the US, direct healthcare costs (in 2023 USD) were applied to hospitalized events and study drugs used by all CHA₂DS₂-VASc score >4 participants. The daily cost of apixaban was $0.63, $0.11, $2.26, and $6.06 for Canada, the UK, Germany and the US. We determined the mean cost per participant for the full duration of the trial (mean follow-up of 3.5 years). If in-trial results were not cost-saving (below $0), we performed a lifetime cost-effectiveness analysis using a Markov model and assumed a willingness to pay of 50,000 USD per Quality Adjust Life-Year (QALY). The Markov model consisted of five states (Alive, Dead, Discontinued, Rankin 0-2 Post-Stroke and Rankin 3-5 Post-Stroke) with a 3-month cycle length. While alive, participants experienced one of eight events (no event, non-fatal myocardial infarction, non-fatal ischemic stroke, fatal ischemic stroke, non-fatal hemorrhagic stroke, fatal hemorrhagic stroke, major gastrointestinal/ genitourinary bleed, or death) based on data from the ARTESiA trial. Costs and utilities were obtained from national tariffs and published literature. Results During the trial, the cost of events was lower in the apixaban arm in all countries. After taking into consideration the cost of study medication, apixaban was cost saving (dominant strategy) in Canada (-$2301) and the UK (-$902) but cost more in Germany and the US ($600 and $1990 respectively) and thus modelling was required for these two countries. Over a lifetime, apixaban results in 4.995 QALYs compared to 4.888 QALYs for patients taking aspirin; a difference of 0.107 QALYs. During this period participants taking apixaban accrued higher costs than those taking aspirin in both Germany ($2623 more) and the US ($9110 more). This resulted in an incremental cost effectiveness ratio of $24,514 for Germany and $85,140 per QALY for the US. One-way sensitivity analyses of drug and event costs and of event probabilities used in our model identified the cost of apixaban as the only factor impacting cost-effectiveness. In the US, this sensitivity analysis indicates a daily cost of $4.35 is required to achieve a willingness-to-pay of $50,000/QALY. Conclusion In patients with device detected atrial fibrillation with CHA₂DS₂-VASc score >4, apixaban is cost-saving in Canada and the UK and cost-effective in Germany. Apixaban is not cost-effective in the US at current prices.Table 1
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,006 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».