| Medical Cost Reductions Associated with the Usage of Novel Oral Anticoagulants vs. Warfarin Among Atrial Fibrillation Patients, Based on the RE-LY, ROCKET-AF and ARISTOTLE Trials. | |
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MedLine Citation:
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PMID: 22449118 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Abstract: Objective: The randomized clinical trials, RE-LY, ROCKET-AF and ARISTOTLE, demonstrate that the novel oral anticoagulants (NOACs) were effective options for stroke prevention among non-valvular atrial fibrillation (AF) patients. This study aimed to evaluate the medical cost reductions associated with the use of individual NOACs instead of warfarin from the US payer perspective. Methods: Rates for efficacy and safety clinical events for warfarin were estimated as the weighted averages from the RE-LY, ROCKET-AF and ARISTOTLE trials and event rates for NOACs were determined by applying trial hazard ratios or relative risk ratios to such weighted averages. Incremental medical costs to a US health payer of an AF patient experiencing a clinical event during one year following the event were obtained from published literature and inflation adjusted to 2010 cost levels. Medical costs, excluding drug costs were evaluated and compared for each NOAC vs. warfarin. Sensitivity analyses were conducted to determine the influence of variations in clinical event rates and incremental costs on the medical cost reduction. Results: In a patient year, the medical cost reduction associated with NOAC usage instead of warfarin was estimated to be -$179, -$89 and -$485 for dabigatran, rivaroxaban and apixaban, respectively. When clinical event rates and costs were allowed to vary simultaneously, through a Monte Carlo simulation, the 95% confidence interval of annual medical costs differences ranged between -$424 and +$71 for dabigatran, -$301 and +$135 for rivaroxaban and -$741 and -$252 for apixaban, with a negative number indicating a cost reduction. Of the 10,000 Monte-Carlo iterations 92.6%, 79.8% and 100.0% were associated with a medical cost reduction >$0 for dabigatran, rivaroxaban and apixaban, respectively. Conclusions: Usage of the NOACs, dabigatran, rivaroxaban, and apixaban may be associated with lower medical (excluding drug costs) costs relative to warfarin, with apixaban having the most substantial medical cost reduction. |
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Authors:
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Steve Deitelzweig; Alpesh Amin; Yonghua Jing; Dinara Makenbaeva; Daniel Wiederkehr; Jay Lin; John Graham |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-3-27 |
Journal Detail:
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Title: Journal of medical economics Volume: - ISSN: 1941-837X ISO Abbreviation: - Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-3-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9892255 Medline TA: J Med Econ Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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