Cost-Effectiveness of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for Stroke Prevention in Atrial Fibrillation
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TLDR
In patients with nonvalvular atrial fibrillation and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg were all cost-effective alternatives to warfarin.Abstract:
Background and Purpose—To estimate the cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation by using novel oral anticoagulants apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg compared with warfarin. Methods—A Markov decision-analysis model was constructed using data from clinical trials to evaluate lifetime costs and quality-adjusted life-years of novel oral anticoagulants compared with warfarin. The modeled population was a hypothetical cohort of 70-year-old patients with nonvalvular atrial fibrillation, increased risk for stroke (CHADS2 ≥1), renal creatinine clearance ≥50 mL/min, and no previous contraindications to anticoagulation. The willingness-to-pay threshold was $50 000/quality-adjusted life-years gained. Results—In the base case, warfarin had the lowest cost of $77 813 (SD, $2223), followed by rivaroxaban 20 mg ($78 738±$1852), dabigatran 150 mg ($82 719±$1959), and apixaban 5 mg ($85 326±$1512). Apixaban 5 mg had the highest quality-adjusted life-year...read more
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Cost-Effectiveness of Left Atrial Appendage Closure With the WATCHMAN Device Compared With Warfarin or Non–Vitamin K Antagonist Oral Anticoagulants for Secondary Prevention in Nonvalvular Atrial Fibrillation
TL;DR: Upfront procedure costs initially make LAAC higher cost than warfarin and the non–vitamin K antagonist oral anticoagulants, but within 10 years, LAAC delivers more quality-adjusted life years and has lower total costs, making LAAC the most cost-effective treatment strategy for secondary prevention of stroke in atrial fibrillation.
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TL;DR: In this article, the authors examined the phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF) without third-party insurance.
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New Oral Anticoagulants May Be Particularly Useful for Asian Stroke Patients
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TL;DR: Four large phase III randomized controlled trials in patients with non-valvular AF demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior towarfarin in terms of intracranial hemorrhage.
New oral anticoagulants may be particularly useful for asian stroke patients.
Oh Young Bang,Keun-Sik Hong,Jong Seung Kim,Byung Woo Yoon,Byung Chul Lee,Hee-Joon Bae,Kyung Ho Yu,Sun U. Kwon,Jaseong Koo,Ji Hoe Heo +9 more
TL;DR: In this paper, Liu et al. showed that oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to Warfarin in terms of intracranial hemorrhage.
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References
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Journal ArticleDOI
Dabigatran versus warfarin in patients with atrial fibrillation
Stuart J. Connolly,Michael D. Ezekowitz,John W. Eikelboom,Jonas Oldgren,Amit Parekh,Janice Pogue,Paul A. Reilly,Ellison Themeles,Jeanne Varrone,Susan Wang,Marco Alings,Denis Xavier,Jun Zhu,Rafael Diaz,Basil S. Lewis,Harald Darius,Hans-Christoph Diener,Campbell D. Joyner,Lars Wallentin +18 more
TL;DR: In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage.
Journal ArticleDOI
Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation
Manesh R. Patel,Kenneth W. Mahaffey,Jyotsna Garg,Guohua Pan,Daniel E. Singer,Werner Hacke,Günter Breithardt,Jonathan L. Halperin,Graeme J. Hankey,Jonathan P. Piccini,Richard C. Becker,Christopher C. Nessel,John F. Paolini,Scott D. Berkowitz,Robert M. Califf +14 more
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Journal ArticleDOI
Apixaban versus Warfarin in Patients with Atrial Fibrillation
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TL;DR: Dariush Mozaffarian, Michael E. Mussolino, Graham Nichol, Nina P. Paynter, Wayne D. Sorlie, Randall S. Stafford, Tanya N. Turan, Melanie B. Turner, Nathan D. Turner.
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