Supplementary materials: US cost–effectiveness analysis of apixaban compared with warfarin, dabigatran and rivaroxaban for nonvalvular atrial fibrillation, focusing on equal value of life years and health years in total

These are peer-reviewed supplementary materials for the article 'US cost–effectiveness analysis of apixaban compared with warfarin, dabigatran and rivaroxaban for nonvalvular atrial fibrillation, focusing on equal value of life years and health years in total' published in the Journal of Comparative Effectiveness Research.Figure S1: Base case modelled clinical event rates per 1,000 patients for over the full time horizonFigure S2: Base case deterministic OWSA: ICER per evLYG for apixaban versus comparator armsFigure S3: Base case deterministic OWSA: ICER per HYTG for apixaban versus comparator armsFigure S4: Probabilistic sensitivity analysis scatter plot (ICER per evLYG) for apixaban versus comparator armsFigure S5: Probabilistic sensitivity analysis scatter plot (ICER per HYTG) for apixaban versus comparator armsFigure S6: Cost-effectiveness acceptability curve (ICER per evLYG): apixaban (5 mg bd) versus comparator armsFigure S7: Clinical event rates per 1,000 patients during first-line treatment (scenario analysis: alternative treatment effects Table S1: Model inputsTable S2: Generic pricing assumptionsTable S3: Clinical event rate hazard ratios for rivaroxaban with apixaban (scenario analysis: alternative treatment effectsTable S4: Summary of costs associated with apixaban and rivaroxaban (scenario analysis: alternative treatment effectsAim: Warfarin and direct-acting oral anticoagulants (DOACs) are widely prescribed to patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of stroke and systemic embolism (SE). This study aimed to assess the cost–effectiveness of apixaban compared with warfarin, dabigatran and rivaroxaban, for patients with NVAF from a US healthcare payer (Medicare) perspective. Methods: A cohort-level Markov model was developed based on a previously published model, for the US setting, factoring in anticipated price decreases due to market entry of generic drugs. Two retrospective cohort studies in US Medicare patients provided inputs to quantify clinical events in the base case setting and in a scenario analysis. For this study, equal value of life-years (evLYs) and health years in total (HYT) were used. Cost–effectiveness was assessed based on a willingness-to-pay threshold of $100,000 per evLY gained (evLYG) or HYT gained (HYTG). Results: Apixaban treatment was associated with gains of 2.23, 1.08 and 1.72 evLYs and 2.26, 1.08 and 1.73 HYTs, comparedwith warfarin, dabigatran and rivaroxaban, respectively. In the base case analysis from a Medicare perspective, apixaban was cost-effective (i.e., value for money) compared with warfarin, dabigatran and rivaroxaban, with corresponding incremental cost–effectiveness ratio (ICER) per evLYG (and HYTG) of $10,501 ($10,350), $7809 ($7769) and $758 ($768), respectively. When a societal perspective was included, and in a scenario analysis using US Medicare data from the Ray et al. study to quantify treatment effects, apixaban dominated rivaroxaban (i.e., less expensive and more effective) in terms of ICER per evLYG (and HYTG). Conclusion: Using dynamic pricing assumptions, treatment with apixaban compared with warfarin, dabigatran and rivaroxaban was associated with incremental evLYs and HYT and represents a cost-effective treatment option in patients with NVAF, from a US healthcare payer (Medicare) perspective.

本数据集为发表于《比较效果研究杂志》之文章《美国非瓣膜性房颤患者应用阿哌沙班与华法林、达比加群和利伐沙班的成本效益分析》的同行评审补充材料。图S1：在完整时间范围内，针对每1000名患者的基线模型临床事件发生率；图S2：基线确定性OWSA：阿哌沙班与对照臂比较的每额外生命年成本效应比（ICER）；图S3：基线确定性OWSA：阿哌沙班与对照臂比较的每健康年成本效应比（ICER）；图S4：阿哌沙班与对照臂比较的每额外生命年成本效应比的概率敏感性分析散点图；图S5：阿哌沙班与对照臂比较的每健康年成本效应比的概率敏感性分析散点图；图S6：成本效益可接受性曲线（每额外生命年成本效应比）：阿哌沙班（每日两次，每次5毫克）与对照臂比较；图S7：一线治疗期间每1000名患者的临床事件发生率（情景分析：替代治疗效应）；表S1：模型输入；表S2：通用定价假设；表S3：利伐沙班与阿哌沙班（情景分析：替代治疗效应）的临床事件发生率风险比；表S4：与阿哌沙班和利伐沙班相关的成本总结（情景分析：替代治疗效应）。研究目的：华法林和直接口服抗凝剂（DOACs）被广泛应用于非瓣膜性房颤（NVAF）患者以降低中风和全身性栓塞（SE）的风险。本研究旨在从美国医疗保健支付者（医疗保险）的角度评估阿哌沙班与华法林、达比加群和利伐沙班相比在NVAF患者中的成本效益。研究方法：基于先前发表模型，构建了一个针对美国环境的队列水平马尔可夫模型，考虑了因通用药物进入市场而预期的价格下降。两项美国医疗保险患者的回顾性队列研究提供了基线设置和情景分析的输入，以量化临床事件。本研究采用等价值生命年（evLYs）和总健康年（HYT）。成本效益评估基于每获得额外生命年（evLYG）或健康年（HYTG）的支付意愿阈值100,000美元。研究结果：与华法林、达比加群和利伐沙班相比，阿哌沙班治疗与2.23、1.08和1.72个额外生命年以及2.26、1.08和1.73个健康年的增加相关。从医疗保险的角度进行的基线分析表明，与华法林、达比加群和利伐沙班相比，阿哌沙班具有成本效益（即物有所值），相应的每额外生命年成本效益比（ICER）分别为10,501美元（10,350美元）、7809美元（7769美元）和758美元（768美元）。当包含社会视角，并在使用Ray等人研究的美国医疗保险数据进行情景分析以量化治疗效应时，阿哌沙班在每额外生命年成本效益比（及每健康年成本效益比）方面优于利伐沙班（即成本更低且效果更佳）。结论：采用动态定价假设，与华法林、达比加群和利伐沙班相比，阿哌沙班治疗与额外的evLYs和HYT相关，并且从美国医疗保健支付者（医疗保险）的角度来看，代表了一种具有成本效益的治疗选择。