alexa Economic Evaluations of Medical Cost Differences: Use of Targeted-Specific Oral Anticoagulants vs. Warfarin among Patients with Nonvalvular Atrial Fibrillation and Venous Thromboembolism in the U.S. | Abstract
ISSN: 2329-8790

Journal of Hematology & Thromboembolic Diseases
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Research Article

Economic Evaluations of Medical Cost Differences: Use of Targeted-Specific Oral Anticoagulants vs. Warfarin among Patients with Nonvalvular Atrial Fibrillation and Venous Thromboembolism in the U.S.

Alpesh Amin1*, Melissa Lingohr-Smith2, Amanda Bruno3, Jeffrey Trocio4 and Jay Lin2
1University of California, Irvine, CA, USA
2Novosys Health, Green Brook, NJ, USA
3Bristol-Myers Squibb, Plainsboro, NJ, USA
4Pfizer, Inc., New York, NY, USA
Corresponding Author : Alpesh Amin, MD
Chair, Department of Medicine
Executive Director, Hospitalist Program
School of Medicine University of California
Irvine, UCIMC; 101 The City Drive South Building 58
Room 110, ZC-4076H, Mail Code: 4076, Irvine, CA 92868, USA
Tel: 714 456-3785
E-mail: [email protected]
Received April 13, 2015; Accepted May 5, 2015; Published May 10, 2015
Citation: Amin A, Lingohr-Smith M, Bruno A, Trocio J, Lin J (2015) Economic Evaluations of Medical Cost Differences: Use of Targeted-Specific Oral Anticoagulants vs. Warfarin among Patients with Nonvalvular Atrial Fibrillation and Venous Thromboembolism in the U.S. J Hematol Thrombo Dis 3:209. doi: 10.4172/2329-8790.1000209
Copyright: © 2015 Amin A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

We have used a series of economic models to evaluate the differences in medical costs associated with the use of each of the four targeted-specific oral anticoagulants (TSOACs), dabigatran, rivaroxaban, apixaban, and edoxaban vs. warfarin for the treatment of nonvalvular atrial fibrillation (NVAF) and venous thromboembolism (VTE). All economic models were based on clinical event rates reported in published randomized phase III clinical trials, except one model used real-world data among patients with VTE. Incremental annual medical costs among NVAF and VTE patients with clinical events from a U.S. payer perspective were obtained from the literature and inflation adjusted to 2013 cost levels. The economic model for NVAF patients estimated that in a year the total medical cost differences associated with TSOAC use relative to warfarin at $204, $140, $495, and -$340 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. The economic model for patients with acute symptomatic VTE estimated that in a year the total medical cost differences associated with TSOAC use relative to warfarin at -$146, -$482, -$918, and -$344 per patient for dabigatran, rivaroxaban, apixaban, and edoxaban, respectively. In all cases, univariate and multivariable sensitivity analyses were conducted to establish the robustness of the results of the economic models. Additionally, we extrapolated the results of our economic models to a combined population of NVAF patients and acute VTE patients among a hypothetical cohort of 1 million insured lives. Our economic evaluations have consistently shown that medical costs are reduced when TSOACs are used instead of warfarin for the treatment of NVAF or VTE, with apixaban being associated with the greatest reduction in medical costs. This review describes the execution of these economic evaluations and their results.

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