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Adoption of new antiglaucoma drugs in Finland: impact of changes in copayment.

https://arctichealth.org/en/permalink/ahliterature159654
Source
Clin Ther. 2007 Nov;29(11):2468-76
Publication Type
Article
Date
Nov-2007
Author
Jaana E Martikainen
Unto Häkkinen
Hannes Enlund
Author Affiliation
Research Department, The Social Insurance Institution, Helsinki, Finland. jaana.martikainen@kela.fi
Source
Clin Ther. 2007 Nov;29(11):2468-76
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Carbonic Anhydrase Inhibitors - economics - therapeutic use
Data Collection
Data Interpretation, Statistical
Drug Utilization
Finland - epidemiology
Glaucoma - drug therapy - economics - epidemiology
Humans
Insurance, Health, Reimbursement
Models, Statistical
Prostaglandins - economics - therapeutic use
Prostaglandins F, Synthetic - economics - therapeutic use
Regression Analysis
Sulfonamides - economics - therapeutic use
Thiophenes - economics - therapeutic use
Abstract
Copayments are common measures intended to control drug expenditures and promote rational prescribing. In Finland, new antiglaucoma drugs start with a high copayment, but once sufficient clinical experience is available, they are reevaluated and can receive a lower copayment status.
This study assessed the effect of changes in copayment level on the adoption of 2 antiglaucoma drugs.
A retrospective analysis was performed from 1997 to 2001 using the Finnish national register of reimbursed drug purchases, which covers approximately 98% of all antiglaucoma drug purchases in the country. There were 172,293 purchases of dorzolamide (plain or combined with timolol) and 281,377 purchases of latanoprost. An interrupted time-series design from approximately 30 months before and 20 months after the change in copayment was used in the analysis. The main outcome measures were the numbers of defined daily doses (DDDs) purchased and the monthly numbers of patients who purchased the study drugs for the first time before and after the change in copayment.
A substantial increase in consumption of both dorzolamide and latanoprost was seen immediately after the introduction of the lower copayment. The monthly consumption of dorzolamide was 60,713 DDDs higher and the monthly consumption of latanoprost was 49,330 DDDs higher than expected according to the utilization trend during the higher copayment period. Twelve months later, the observed consumption of dorzolamide was 109% higher and that of latanoprost was 21% higher than if the copayment had remained the same. The number of new patients using the study drugs peaked within 2 months of the lower copayment, but the amount consumed per patient per day remained quite stable.
Decreasing the copayment of a new antiglaucoma drug to the same level as the copayments of alternative drugs accelerated the adoption of these new products in Finland.
PubMed ID
18158088 View in PubMed
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An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials.

https://arctichealth.org/en/permalink/ahliterature80464
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Publication Type
Article
Date
Dec-2006
Author
Borgström F.
Jönsson B.
Ström O.
Kanis J A
Author Affiliation
Stockholm Health Economics, Vasagatan 38, 2nd floor, SE-111 21 Stockholm, Sweden. fredrik.b@healtheconomics.se
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density Conservation Agents - economics - therapeutic use
Clinical Trials, Phase III
Cost-Benefit Analysis - economics
Female
Fractures, Bone - epidemiology - etiology
Health Care Costs
Humans
Markov Chains
Organometallic Compounds - economics - therapeutic use
Osteoporosis, Postmenopausal - drug therapy - economics - epidemiology
Quality of Life
Quality-Adjusted Life Years
Risk factors
Sweden - epidemiology
Thiophenes - economics - therapeutic use
Treatment Outcome
Abstract
INTRODUCTION: Strontium ranelate is a new therapy for the treatment and prevention of osteoporosis that has been shown in two phase III clinical trials (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and the Treatment Of Peripheral OSteoporosis Study [TROPOS] trials) to reduce the risk of osteoporotic fractures at the vertebral, non-vertebral and hip level in postmenopausal women. The aim of this study was to estimate the potential cost-effectiveness of strontium ranelate in the treatment of osteoporosis in postmenopausal Swedish patients. METHODS: A Markov cohort model was adapted to fit patients corresponding to the patients in the SOTI and TROPOS clinical trials. The model was populated with Swedish cost and epidemiological data. In the base case, the cost-effectiveness was estimated for 69-year old women with low bone mineral density (BMD) and prevalent vertebral fractures (SOTI) and for 77-year old women with low BMD (TROPOS). The cost-effectiveness analysis had a societal perspective. RESULTS: In the base case analysis, the cost per quality-adjusted life years (QALY) gained of strontium ranelate patients compared to no treatment patients was estimated at SEK 472,586 and SEK 259,643, including costs in added life years, based on the SOTI and the TROPOS trials, respectively. Excluding cost in added life years, the cost per QALY gained was estimated at SEK 336,420 (SOTI) and SEK 165,680 (TROPOS). In subgroup analyses, in patients 74 years and older with a T-score lower than -2.4 and patients older than 80 years of age, strontium ranelate was found to be cost saving compared to no treatment. CONCLUSIONS: The results in the base case analyses and the sensitivity analyses of this study indicate that, compared to no treatment, strontium ranelate is cost-effective in the treatment of postmenopausal women with low BMD.
PubMed ID
17009083 View in PubMed
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Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US.

https://arctichealth.org/en/permalink/ahliterature108612
Source
Appl Health Econ Health Policy. 2013 Oct;11(5):485-97
Publication Type
Article
Date
Oct-2013
Author
Anju Parthan
Morgan Kruse
Nicole Yurgin
Joice Huang
Hema N Viswanathan
Douglas Taylor
Author Affiliation
OptumInsight, Cambridge, MA, USA, anju.parthan@optum.com.
Source
Appl Health Econ Health Policy. 2013 Oct;11(5):485-97
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Cost-Benefit Analysis
Diphosphonates - economics - therapeutic use
Drug Costs
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Health Care Costs - statistics & numerical data
Humans
Insurance, Health, Reimbursement - economics - statistics & numerical data
Markov Chains
Osteoporosis, Postmenopausal - economics - prevention & control
Sweden
Thiophenes - economics - therapeutic use
United States
Abstract
In the US, 26 % of women aged =65 years, and over 50 % of women aged =85 years are affected with postmenopausal osteoporosis (PMO). Each year, the total direct health care costs are estimated to be $US12-18 billion.
The cost effectiveness of denosumab versus oral bisphosphonates in postmenopausal osteoporotic women from a US third-party payer perspective was evaluated.
A lifetime cohort Markov model was developed with seven health states: 'well', hip fracture, vertebral fracture, 'other' osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Relative fracture risk reductions, background fracture risks, mortality rates, treatment-specific persistence rate, utilities, and medical and drug costs were derived using published sources. Expected costs and quality-adjusted life years (QALYs) were estimated for generic alendronate, denosumab, branded risedronate, and branded ibandronate in the overall PMO population and high-risk subgroups: (a) =2 of the following risks: >70 years of age, bone mineral density (BMD) T score less than or equal to -3.0, and prevalent vertebral fracture; and (b) =75 years of age. Costs and QALYs were discounted at 3 % annually, and all costs were inflated to 2012 US dollars. Sensitivity analyses were conducted by varying parameters e.g., efficacies of interventions, costs, utilities, and the medication persistence ratio.
In the overall PMO population, total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were $US64,400, $US67,400, $US67,600 and $US69,200, respectively. Total QALYs were 8.2804, 8.3155, 8.2735 and 8.2691, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus generic alendronate was $US85,100/QALY. Risedronate and ibandronate were dominated by denosumab. In the high-risk subgroup (a), total costs for alendronate, denosumab, risedronate and ibandronate were $US70,400, $US70,800, $US74,000 and $US76,900, respectively. Total QALYs were 7.2006, 7.2497, 7.1969 and 7.1841, respectively. Denosumab had an ICER of $US7,900/QALY versus generic alendronate and dominated all other strategies. Denosumab dominated all strategies in women aged =75 years. Base-case results between denosumab and generic alendronate were most sensitive to the relative risk of hip fracture for both drugs and the cost of denosumab.
In each PMO population examined, denosumab represented good value for money compared with branded bisphosphonates. Furthermore, denosumab was either cost effective or dominant compared with generic alendronate in the high-risk subgroups.
PubMed ID
23868102 View in PubMed
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Cost effectiveness of duloxetine compared with venlafaxine-XR in the treatment of major depressive disorder.

https://arctichealth.org/en/permalink/ahliterature173424
Source
Curr Med Res Opin. 2005 Aug;21(8):1271-9
Publication Type
Article
Date
Aug-2005
Author
M. van Baardewijk
P M J Vis
T R Einarson
Author Affiliation
Faculty of Pharmacy, University of Utrecht, Netherlands.
Source
Curr Med Res Opin. 2005 Aug;21(8):1271-9
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cost of Illness
Cost-Benefit Analysis
Cyclohexanols - economics - therapeutic use
Decision Trees
Depressive Disorder, Major - drug therapy - economics
Economics, Pharmaceutical
Health Care Costs
Humans
Middle Aged
Models, Econometric
Norepinephrine - antagonists & inhibitors
Ontario
Outpatients
Serotonin Uptake Inhibitors - economics - therapeutic use
Thiophenes - economics - therapeutic use
Treatment Outcome
Abstract
To determine the cost effectiveness of duloxetine, a new serotonin norepinephrine reuptake inhibitor, when compared with venlafaxine-XR in treating major depressive disorder.
A cost effectiveness analysis, using a decision tree modelled outpatient treatment over 6 months. Analytic perspectives were those of society (all direct and indirect costs) and the Ministry of Health of Ontario (MoH) as payer for all direct costs. Rates of success and dropouts were obtained from a meta-analysis of randomized placebo-controlled trials. Costs were taken from standard lists, adjusted to 2005 Canadian dollars; discounting was not applied. One-way sensitivity analyses were performed on monthly acquisition costs and success rates; Monte-Carlo analysis examined all parameters over 10000 iterations.
From both perspectives, outcomes all numerically favoured venlafaxine-XR (Expected success = 53% and 57%; symptom-free days [SFDs] = 52.72 and 57.03 for duloxetine and venlafaxine-XR, respectively). Total expected costs/patient treated were, Can dollar 7081 and Can dollar 6551 (MoH), Can dollar 20987 and Can dollar 19 997 (societal perspective), for duloxetine and venlafaxine-XR, respectively. Expected costs/SFD were Can dollar134 and Can dollar 115 (MoH) and Can dollar 398 and Can dollar 351 (societal viewpoint) for duloxetine and venlafaxine-XR, respectively. Although results were sensitive to changes in success rate within the 95% CI, Monte-Carlo analyses using the ICER (incremental cost effectiveness ratio) as outcome found venlafaxine-XR was dominant in approximately 78% of scenarios in both perspectives.
Differences in pharmacoeconomic outcomes found were modest, but in all cases, favoured venlafaxine-XR over duloxetine. Therefore, a possible advantage may exist at the population level in the treatment of major depressive disorder in Canada. Ultimately, a head to head study of the two drugs would be needed to confirm these findings.
PubMed ID
16083537 View in PubMed
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Cost effectiveness of duloxetine for osteoarthritis: a Quebec societal perspective.

https://arctichealth.org/en/permalink/ahliterature104245
Source
Arthritis Care Res (Hoboken). 2014 May;66(5):702-8
Publication Type
Article
Date
May-2014
Author
Ronald C Wielage
Ankur J Patel
Megha Bansal
Shannon Lee
Robert W Klein
Michael Happich
Source
Arthritis Care Res (Hoboken). 2014 May;66(5):702-8
Date
May-2014
Language
English
Publication Type
Article
Keywords
Analgesics - economics - therapeutic use
Analgesics, Opioid - economics - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - economics - therapeutic use
Cohort Studies
Cost-Benefit Analysis
Female
Humans
Male
Markov Chains
Middle Aged
Osteoarthritis - drug therapy - economics - epidemiology
Quebec - epidemiology
Socioeconomic Factors
Thiophenes - economics - therapeutic use
Abstract
To assess the cost effectiveness of duloxetine compared to other oral postacetaminophen treatments for osteoarthritis (OA) from a Quebec societal perspective.
A cost-utility analysis was performed enhancing the Markov model from the 2008 OA guidelines of the National Institute for Health and Clinical Excellence (NICE). The NICE model was extended to include opioid and antidepressant comparators, adding titration, discontinuation, and relevant adverse events (AEs). Comparators included duloxetine, celecoxib, diclofenac, naproxen, hydromorphone, and oxycodone extended release (oxycodone). AEs included gastrointestinal and cardiovascular events associated with nonsteroidal antiinflammatory drugs (NSAIDs), as well as fracture, opioid abuse, and constipation, among others. Costs and incremental cost-effectiveness ratios (ICERs) were estimated in 2011 Canadian dollars. The base case modeled a cohort of 55-year-old patients with OA for a 12-month period of treatment, followed by treatment from a basket of post-discontinuation oral therapies until death. Sensitivity analyses (one-way and probabilistic) were conducted.
Overall, naproxen was the least expensive treatment, whereas oxycodone was the most expensive. Duloxetine accumulated the highest number of quality-adjusted life years (QALYs), with an ICER of $36,291 per QALY versus celecoxib. Duloxetine was dominant over opioids. In subgroup analyses, ICERs for duloxetine versus celecoxib were $15,619 and $20,463 for patients at high risk of NSAID-related AEs and patients ages >65 years, respectively.
Duloxetine was cost effective for a cohort of 55-year-old patients with OA, and more so in older patients and those with greater AE risks.
PubMed ID
24877251 View in PubMed
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Cost-effectiveness of rivaroxaban in the prevention of venous thromboembolism: A Canadian analysis using the Ontario Ministry of Health Perspective.

https://arctichealth.org/en/permalink/ahliterature125307
Source
J Med Econ. 2012;15(5):817-28
Publication Type
Article
Date
2012
Author
Heather McDonald
Alex Diamantopoulos
Philip Wells
Michael Lees
Kerstin Folkerts
Fiona Forster
Jaithri Ananthapavan
Author Affiliation
Bayer Inc., Toronto, Canada. heather.mcdonald@bayer.com
Source
J Med Econ. 2012;15(5):817-28
Date
2012
Language
English
Publication Type
Article
Keywords
Anticoagulants - economics - therapeutic use
Arthroplasty, Replacement, Hip
Cost-Benefit Analysis
Humans
Morpholines - economics - therapeutic use
Ontario
Postoperative Complications - prevention & control
Thiophenes - economics - therapeutic use
Venous Thromboembolism - prevention & control
Abstract
A cost-effectiveness model for rivaroxaban evaluated the cost-effectiveness of prophylaxis with rivaroxaban (a once-daily, orally administered Factor Xa inhibitor) vs enoxaparin in the prevention of venous thromboembolism (VTE) after total hip replacement (THR) and total knee replacement (TKR). This Canadian analysis was conducted using the Ontario Ministry of Health perspective over a 5-year time horizon. The model combined clinical data and builds upon existing economic models.
The model included both acute VTE (represented as a decision tree) and long-term complications (represented as a Markov process with 1-year cycles) phases. The model allowed VTE event rates, quality-adjusted life expectancy and direct medical costs to be estimated over a 5-year time horizon, based on current approved practice patterns in Canada. A number of one-way sensitivity analyses were performed on the baseline assumptions, including a comparison of rivaroxaban with dalteparin, and probabilistic sensitivity analyses were performed to address any uncertainty concerning model inputs.
When comparing equal durations of therapy, rivaroxaban dominated enoxaparin in the prevention of VTE events in patients undergoing THR and TKR, providing more benefit at a lower cost. Rivaroxaban was cost-effective when comparing 35 days' prophylaxis with 14 days' prophylaxis with enoxaparin following THR. One-way and probabilistic sensitivity analyses demonstrated that the results of the economic analysis were robust to variations in key inputs. Rivaroxaban remained dominant during one-way sensitivity analyses comparing rivaroxaban with dalteparin after THR or TKR.
Although clinical trial data were used in the prophylaxis module, assumptions and values used in the post-prophylaxis and long-term complication (LTC) modules were based on several different literature sources; it was not always possible to source Canadian data.
This economic analysis suggests that the use of rivaroxaban for the prophylaxis of VTE after THR or TKR in Canada was cost-effective.
PubMed ID
22494267 View in PubMed
Less detail

Cost-effectiveness of rivaroxaban versus enoxaparin for the prevention of postsurgical venous thromboembolism in Canada.

https://arctichealth.org/en/permalink/ahliterature141138
Source
Thromb Haemost. 2010 Oct;104(4):760-70
Publication Type
Article
Date
Oct-2010
Author
Alexander Diamantopoulos
Michael Lees
Philip S Wells
Fiona Forster
Jaithri Ananthapavan
Heather McDonald
Author Affiliation
Symmetron Limited, London, UK.
Source
Thromb Haemost. 2010 Oct;104(4):760-70
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Canada
Cost-Benefit Analysis - methods
Enoxaparin - economics - therapeutic use
Follow-Up Studies
Humans
Morpholines - economics - therapeutic use
Postoperative Complications
Quality of Life
Sensitivity and specificity
Thiophenes - economics - therapeutic use
Venous Thromboembolism - etiology - prevention & control
Abstract
This study aimed to evaluate the cost-effectiveness of prophylaxis with rivaroxaban vs. enoxaparin in the prevention of venous thromboembolism (VTE) after total hip replacement (THR) and total knee replacement (TKR) from the perspective of the Canadian healthcare system. A model was developed that included both acute VTE (represented as a decision tree) and long-term complications (represented as a Markov process with one-year cycles). Transition probabilities were derived from phase III clinical trials comparing rivaroxaban with enoxaparin and published literature. Costs were derived from the Ontario Case Costing Initiative and publicly available sources. Utilities were derived from published literature. The model reported VTE event rates, quality-adjusted life expectancy and direct medical costs over a five-year horizon. Costs are reported in 2007 Canadian Dollars (C$). When rivaroxaban and enoxaparin are compared in patients undergoing THR, rivaroxaban dominates enoxaparin. That is, rivaroxaban is associated with improved health outcomes as measured by increased quality-adjusted life years (QALYs; 0.0006) and fewer symptomatic VTE events (0.0061), and also with lower cost (savings of C$300) per patient. Similarly, rivaroxaban dominates enoxaparin in patients undergoing TKR, achieving a gain of 0.0018 QALYs, a reduction of 0.0192 symptomatic venous thromboembolic events and savings of C$129 per patient. Rivaroxaban is a cost-effective alternative to enoxaparin for VTE prophylaxis in patients undergoing THR and TKR. Over a five-year horizon, rivaroxaban dominated enoxaparin in the prevention of VTE events in patients undergoing THR and TKR, providing more quality-of-life benefit at a lower cost.
PubMed ID
20806107 View in PubMed
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Cost-effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden.

https://arctichealth.org/en/permalink/ahliterature130880
Source
Expert Rev Pharmacoecon Outcomes Res. 2011 Oct;11(5):601-15
Publication Type
Article
Date
Oct-2011
Author
Lars Ryttberg
Alex Diamantopoulos
Fiona Forster
Michael Lees
Anina Fraschke
Ingela Björholt
Author Affiliation
Orthopedic Department, Örebro University Hospital, USÖ SE 70185, Örebro, Sweden.
Source
Expert Rev Pharmacoecon Outcomes Res. 2011 Oct;11(5):601-15
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Anticoagulants - therapeutic use
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Cost-Benefit Analysis
Heparin - economics - therapeutic use
Humans
Models, Economic
Morpholines - economics - therapeutic use
Sweden
Thiophenes - economics - therapeutic use
Venous Thromboembolism - prevention & control
Abstract
The objective of this study was to evaluate the cost-effectiveness of rivaroxaban versus the low-molecular-weight heparins (LMWH) enoxaparin and dalteparin for the prevention of venous thromboembolism (VTE) after total hip replacement and total knee replacement in Sweden.
The model included acute venous thromboembolic events and long-term complications over a 5-year time horizon represented by an acute and a chronic phase with 1-year cycles. Transition probabilities were derived from the Regulation of Coagulation in Orthopaedic Surgery to Prevent Deep Vein Thrombosis and Pulmonary Embolism (RECORD) clinical trials.
In patients undergoing total hip replacement, the incremental cost per additional quality-adjusted life-year of extended prophylaxis for 35 days with rivaroxaban versus 14 days of prophylaxis with enoxaparin or dalteparin was SEK29,400 and SEK35,400, respectively. In total knee replacement patients, 14 days of rivaroxaban dominated 14 days of LMWH as prophylaxis for VTE.
The results of the economic model consistently showed that, over a 5-year period, rivaroxaban is a cost-effective alternative to 14 days of LMWH for VTE prophylaxis in Sweden.
PubMed ID
21958104 View in PubMed
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Cost-effectiveness of strontium ranelate for the prevention and treatment of osteoporosis.

https://arctichealth.org/en/permalink/ahliterature100486
Source
Expert Rev Pharmacoecon Outcomes Res. 2010 Aug;10(4):359-66
Publication Type
Article
Date
Aug-2010
Author
Mickaël Hiligsmann
Marie Vanoverberghe
Audrey Neuprez
Olivier Bruyère
Jean-Yves Reginster
Author Affiliation
Pharmacoeconomics Unit Research, HEC-School of Management, University of Liège, Avenue de l'hôpital 3, Bat B23, 4000 Liège, Belgium. m.hiligsmann@ulg.ac.be
Source
Expert Rev Pharmacoecon Outcomes Res. 2010 Aug;10(4):359-66
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Bone Density Conservation Agents - economics - therapeutic use
Cost-Benefit Analysis
Drug Costs
Evidence-Based Medicine
Female
Fractures, Bone - economics - etiology - prevention & control
Humans
Male
Models, Economic
Organometallic Compounds - economics - therapeutic use
Osteoporosis - complications - drug therapy - economics - prevention & control
Patient Selection
Risk assessment
Sex Factors
Thiophenes - economics - therapeutic use
Treatment Outcome
Abstract
Strontium ranelate has been introduced recently for the prevention and treatment of osteoporosis in Europe and in many countries worldwide. This article reviews the published cost-effectiveness literature pertaining to strontium ranelate. Six studies were identified: two in the UK, two in Belgium and two in Sweden. The findings were consistent across the literature, suggesting that strontium ranelate is a cost-saving drug for women with osteoporosis aged over 80 years, and it is a cost-effective treatment compared with no treatment for osteoporotic women aged over 70 years and for younger women with clinical risk factors for fragility fracture. Strontium ranelate was also shown to be cost effective compared with branded risedronate in osteoporotic women aged over 75 years. Further analyses are required to assess the effectiveness and adherence to strontium ranelate in real-life settings, as well as to evaluate the cost-effectiveness of strontium ranelate in other countries and in populations of men.
PubMed ID
20715911 View in PubMed
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Economic evaluation of warfarin, dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature263034
Source
Pharmacoeconomics. 2014 Jun;32(6):601-12
Publication Type
Article
Date
Jun-2014
Author
Torbjørn Wisløff
Gunhild Hagen
Marianne Klemp
Source
Pharmacoeconomics. 2014 Jun;32(6):601-12
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - adverse effects - economics - therapeutic use
Atrial Fibrillation - complications - drug therapy - economics
Benzimidazoles - economics - therapeutic use
Cost-Benefit Analysis
Decision Support Techniques
Humans
Markov Chains
Models, Statistical
Morpholines - economics - therapeutic use
Norway
Pyrazoles - economics - therapeutic use
Pyridones - economics - therapeutic use
Quality-Adjusted Life Years
Risk factors
Stroke - economics - prevention & control
Thiophenes - economics - therapeutic use
Warfarin - economics - therapeutic use
beta-Alanine - analogs & derivatives - economics - therapeutic use
Abstract
Atrial fibrillation is a major risk factor for stroke, which causes thousands of deaths and sequelae. It is recommended that atrial fibrillation patients at medium or high risk of stroke use an oral anticoagulant to reduce the risk of stroke. In the past few years, three new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, have been introduced in competition to the older oral anticoagulant warfarin.
The objective of this study was to evaluate the relative cost effectiveness of warfarin, dabigatran, rivaroxaban, and apixaban in a Norwegian setting.
We created a probabilistic decision-analytic Markov model to simulate the life of patients with atrial fibrillation. We performed several scenario analyses, including changing the switching age for dabigatran from 80 to 75 years old.
Assuming the European Society of Cardiology guidance, sequential dabigatran (2 Ã? 150 mg daily until 80 years old, 2 Ã? 110 mg thereafter) seems to be the most cost-effective alternative for high-risk AF patients. For medium-risk patients, apixaban (2 Ã? 5 mg daily) seems to be somewhat more effective than dabigatran, but dabigatran is still marginally the most cost-effective alternative. In scenario analyses reducing dabigatran from 2 Ã? 150 mg to 2 Ã? 110 mg at the age of 75 years (instead of at age 80), apixaban (2 Ã? 5 mg daily) becomes the most cost-effective alternative for both risk groups.
We have found apixaban or sequential dabigatran to be the alternatives most likely to be considered cost effective, depending on the switching age for dabigatran. These conclusions are highly sensitive to assumptions made in the analysis.
Notes
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