1. 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

2. Disclosure
This study has been funded by BMS and Pfizer

3. 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: ) Stroke 1991;22:983
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4. 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)
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5. 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) 2) Eur Heart J 2006; 27: 949–53. 3) // Rev Argent Cardiol 2003;71: // Rev Argent Cardiol 2005;73:
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6. 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
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7. 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) )
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8. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
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9. 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
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10. 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
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11. 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
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12. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
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13. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
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14. 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
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15. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
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16. 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
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17. Results QALYs gained Ispor la 2013
Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
QALYs gained
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18. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
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19. Estimation of the Cost-Effectiveness of Apixaban in Non-Valvular Atrial Fibrillation in Argentina
Results
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20. 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
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