Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Giorgi MA1, Caroli C2, Micone P3, Giglio ND4, Aiello EC5, Donato BMK6, Mould JF7, Vulcano C5, Radero G8, Casas M8 1- CEMIC, Buenos Aires, Argentina, 2- FLENI, Buenos Aires, Argentina, 3- Universidad Austral, Buenos Aires, Argentina, 4- Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina, 5- Bristol-Myers Squibb, Buenos Aires, Argentina, 6- Bristol-Myers Squibb, Wallingford, CT, USA, 7- Pfizer, Inc., New York, NY, USA, 8Pfizer, Inc., Buenos Aires, Argentina

Disclosure This study has been funded by BMS and Pfizer

The Burden of Atrial Fibrillation Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Background The Burden of Atrial Fibrillation Atrial fibrillation affects to 2-3 % of the general population1, 2. Its prevalence increases with age 1, 2 An estimated prevalence in the elderly is about 8%3 It increases 5-fold the risk of stroke or systemic embolism4 1) Lancet 2009;373:739 2) Wolf PA. Am Heart J 1996;131:790 3) Eur Heart J 2006; 27: 949 4) Stroke 1991;22:983 Ispor la 2013

The Burden of Atrial Fibrillation Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Background The Burden of Atrial Fibrillation Treatment options1: Older: aspirin / aspirin + clopidogrel vitamin-K antagonists (warfarin / acenocoumarol) Novel: Direct thrombin inhibitors (dabigatran) Factor Xa Inhibitors (apixaban / rivaroxaban) 1) http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-afib-FT.pdf Ispor la 2013

Estimation of the Burden of Atrial Fibrillation Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Background Estimation of the Burden of Atrial Fibrillation in Argentina In 2012, the Argentinean population was estimated around 42,192,494 with 11.1% (4,699,166) over 65 years of age1. Estimated NVAF prevalence in the group of 65 and older is 8% (375,933)2. About 79% (296,987) are suitable for the use of anticoagulants3 1) www.indec.gov.ar. 2) Eur Heart J 2006; 27: 949–53. 3) www.sac.org.ar/files/files/37congreso/TLP%20398.pdf // Rev Argent Cardiol 2003;71:332-37 // Rev Argent Cardiol 2005;73:192-200 Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Objectives To estimate the cost – effectiveness of apixaban in non-valvular Atrial Fibrillation in Argentina To compare the cost-effectiveness of apixaban versus all other therapeutic options available Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Methods Model: Excel based Markov decision tree cost-effectiveness model (previously submitted to NICE in the UK with a positive STA guidance, TA 2751). 1) ) http://publications.nice.org.uk/apixaban-for-preventing-stroke-and-systemic-embolism-in-people-with-nonvalvular-atrial-fibrillation-ta275 Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Ispor la 2013

Expert´s Opinion: 2 modified Delphi panels Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Methods Expert´s Opinion: 2 modified Delphi panels Panel 1: 6 neurologists Panel 2: 7 haematologists w/ clinical experience in AF anticoagulated patients and in stroke representing the 3 health subsectors Ispor la 2013

Resource utilization and Costs: Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Methods Resource utilization and Costs: Obtained from local sources Adapted for each health care subsector Weighted average cost: cost for each subsector * proportion of the population covered by each subsector Expressed in 2012 USD Cost – Effectiveness Threshold: WHO CHOICE: according to per capita GDP Argentina: per capita GDP in 2012 (World Bank data) = USD 11558 Lower Threshold = USD 11558 Upper Threshold= USD 34674 Ispor la 2013

Uncertainty: Model Settings Data with 95%CI Sensitivity Analysis: Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Methods Uncertainty: Data with 95%CI Sensitivity Analysis: Discount Rate Population´s age Anticoagulation Control Quality Probabilistic Sensitivity Analysis Model Settings Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results* * Costs reflect the payer perspective and therefore differ from list prices Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Ispor la 2013

Results Life years gained Ispor la 2013 Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Life years gained Ispor la 2013

Results QALYs gained Ispor la 2013 Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results QALYs gained Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Results Ispor la 2013

Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina Conclusions AF population in Argentina has higher thrombotic risk and less tight anticoagulant control than other countries. Considering WHO-CHOICE CE thresholds, apixaban seems to be a cost effective alternative. These results were consistent both in VKA suitable and unsuitable populations Ispor la 2013