한국 비판막성 심방세동 환자의 뇌졸중 위험 감소에 대한 리바록사반의 경제성평가
Cost-Effectiveness of Rivaroxaban versus Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation Patients in Korea
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Objectives: To evaluate the cost-effectiveness of new oral anticoagulant rivaroxaban compared to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation in the Korea healthcare setting. Methods: A cost-effectiveness analysis of rivaroxaban versus warfarin was performed in Korea from a restricted societal perspective. A Markov model was developed and adapted to the Korean healthcare setting to evaluate the clinical and economic consequences of rivaroxaban versus warfarin. Baseline event rates and efficacy data were obtained from the results of a large double-blind, randomized controlled clinical trial. The population evaluated was patients with non-valvular atrial fibrillation at a moderate to high risk of stroke. The model consists of health states covering the management and outcome of atrial fibrillation. Costs and utilities were assigned to each state to reflect the burden of therapy. Utility values for events were based on literature. Local cost data estimation was based on published price lists, healthcare statistics and local market research data. The cycle length was 3 months and the time horizon of analysis was over a patient life time (30 years). An incremental cost effectiveness ratio (ICER) was evaluated using cost and quality-adjusted life years gained (QALY). Both costs and outcomes were discounted at 5%. One-way sensitivity analyses were conducted on key variables to deal with uncertainty. Results: Rivaroxaban was cost-effective compared to warfarin with an ICER of KRW 12,550,023 (incremental QALYs of 0.26 and incremental costs of KRW 3,270,756). Sensitivity analysis with nursing cost indicated rivaroxaban was a dominant alternative. Also the one-way sensitivity analyses ranging from KRW 1,057,895/QALY to KRW/QALY 19,021,292 indicated that rivaroxaban was cost-effective. Conclusion: Prevention of stroke with rivaroxaban in the population of non-valvular atrial fibrillation patients at a moderate to high risk of stroke is cost-effective compared to warfarin in the Korean healthcare setting.
Abstract
Objectives: To evaluate the cost-effectiveness of new oral anticoagulant rivaroxaban compared to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation in the Korea healthcare setting. Methods: A cost-effectiveness analysis of rivaroxaban versus warfarin was performed in Korea from a restricted societal perspective. A Markov model was developed and adapted to the Korean healthcare setting to evaluate the clinical and economic consequences of rivaroxaban versus warfarin. Baseline event rates and efficacy data were obtained from the results of a large double-blind, randomized controlled clinical trial. The population evaluated was patients with non-valvular atrial fibrillation at a moderate to high risk of stroke. The model consists of health states covering the management and outcome of atrial fibrillation. Costs and utilities were assigned to each state to reflect the burden of therapy. Utility values for events were based on literature. Local cost data estimation was based on published price lists, healthcare statistics and local market research data. The cycle length was 3 months and the time horizon of analysis was over a patient life time (30 years). An incremental cost effectiveness ratio (ICER) was evaluated using cost and quality-adjusted life years gained (QALY). Both costs and outcomes were discounted at 5%. One-way sensitivity analyses were conducted on key variables to deal with uncertainty. Results: Rivaroxaban was cost-effective compared to warfarin with an ICER of KRW 12,550,023 (incremental QALYs of 0.26 and incremental costs of KRW 3,270,756). Sensitivity analysis with nursing cost indicated rivaroxaban was a dominant alternative. Also the one-way sensitivity analyses ranging from KRW 1,057,895/QALY to KRW/QALY 19,021,292 indicated that rivaroxaban was cost-effective. Conclusion: Prevention of stroke with rivaroxaban in the population of non-valvular atrial fibrillation patients at a moderate to high risk of stroke is cost-effective compared to warfarin in the Korean healthcare setting.
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