Apixaban for the prevention of venous thromboembolism in people ...

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Results: Total hip replacement For THR, apixaban remained dominant compared to enoxaparin and dabigatran for all changes in the one-way sensitivity analysis. Apixaban saved more than £30,000 per QALY lost, and was thus cost-effective, as opposed to rivaroxaban, only for a time horizon of 10 years or lower, when age at surgery was 80 years, when the ‘total VTE and all-cause death parameter for rivaroxaban was set at +10% or at its upper 95% confidence interval, and when the upper 95% confidence interval was used for the ‘bleeding events’ parameter for rivaroxaban. In all scenario analyses apixaban dominated enoxaparin and dabigatran. The ICER of apixaban compared to rivaroxaban was similar or lower in all scenario analyses. Since the ICER represents costs saved per QALY lost for apixaban versus rivaroxaban, this indicates that the results of the scenario analyses were all in favour of rivaroxaban. Table 5.19 shows the results of those sensitivity or scenario analyses that impacted the conclusions for THR. Table 5.19 Results of one-way sensitivity and scenario analysis in THR that change the conclusions of the deterministic analysis (based on MS-Table 98 and MS-Table 101) Apixaban vs. rivaroxaban Results 58 Incremental costs Incremental QALYs ICER Base case -£29.47 -0.0014 £21,661 Time Horizon 1 year –£31.98 –0.0001 £269,744 Time Horizon 5 year –£30.33 –0.0005 £63,311 Time Horizon 10 year –£29.93 –0.0008 £35,527 Age at surgery 80 years –£30.27 –0.0007 £41,990 Comparator worse composite ‘Total VTE and all-cause death’ +10% Comparator worse composite ‘Total VTE and all-cause death’ - upper 95% CI –£31.83 –0.0007 £47,603 –£45.97 0.0035 Apixaban dominant Comparator worse ‘bleeding events’ - upper 95% CI –£44.56 –0.0014 £32,775 The results of the PSA showed that at a threshold of £20,000 per QALY, apixaban had 100% probability of being cost-effective compared to enoxaparin (Figure 5.3), a 100% probability of being cost-effective compared to dabigatran (Figure 5.4) and a 55% probability of being cost-effective compared to rivaroxaban (Figure 5.5). At a threshold of £30,000 per QALY, these probabilities were 100%, 100% and 36%, respectively. Copyright 2011 Queen’s Printer and Controller of HMSO. All rights reserved.
Figure 5.3 Cost-effectiveness acceptability curve for apixaban versus enoxaparin in THR (Fig 3 MS-Appendix 23) Figure 5.4 Cost-effectiveness acceptability curve for apixaban versus dabigatran in THR (Fig 5 MS-Appendix 23) 59 Copyright 2011 Queen’s Printer and Controller of HMSO. All rights reserved.
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in collaboration with: Apixaban for
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Abbreviations AAOS American Academy
Page 5 and 6:
1. SUMMARY ........................
Page 7 and 8: 1. SUMMARY 1.1 Scope of the manufac
Page 9 and 10: The three identified trials, which
Page 11 and 12: Table 2.1. Summary of Annual TKR an
Page 13 and 14: The NICE clinical guideline on redu
Page 15 and 16: Indirect and mixed treatment compar
Page 17 and 18: 4.1.2 State the inclusion/exclusion
Page 19 and 20: APROPOS 2 0 Phase II, randomised, e
Page 21 and 22: 4.2 Summary and critique of submitt
Page 23 and 24: Table 4.5: Results for Apixaban ver
Page 25 and 26: Trial no. (acronym) ADVANCE 1 ADVAN
Page 27 and 28: 4.2.4 Describe and critique the man
Page 29 and 30: Table 4.9: Results from indirect co
Page 31 and 32: Results for the main outcomes from
Page 33 and 34: 5 COST EFFECTIVENESS 5.1 ERG commen
Page 35 and 36: Table 5.1 Main findings of studies
Page 37 and 38: 5.2.2 Model structure The manufactu
Page 39 and 40: died in the decision tree enter the
Page 41 and 42: Administration of apixaban is oral,
Page 43 and 44: A mixed treatment comparison (MTC)
Page 45 and 46: Long term recurrent risks of VTE an
Page 47 and 48: 5.2.7 Health related quality of lif
Page 49 and 50: on assumptions, and not further jus
Page 51 and 52: Table 5.12 Costs for health states
Page 53 and 54: Table 5.14 Drug and administration
Page 55 and 56: Comment - The ERG restructured the
Page 57: 5.2.10 Sensitivity analyses Methods
Page 61 and 62: Figure 5.6 Cost-effectiveness accep
Page 63 and 64: Cost-Effectiveness Acceptability Cu
Page 65 and 66: Cost-Effectiveness Acceptability Cu
Page 67 and 68: number of QALYs gained by dabigatra
Page 69 and 70: 5.4 Conclusions Describe the comple
Page 71 and 72: References [1] White RH. The epidem
Page 73 and 74: [23] Eriksson BI, Dahl OE, Rosenche
Page 75 and 76: ISPOR 11th Annual European Congress
Page 77 and 78: Appendix 1A: ERG Search Strategies
Page 79 and 80: 85 84 not 83 (88613) 86 1 or 2 or 3
Page 81 and 82: 76 Comment/ (451657) 77 Letter/ (72
Page 83 and 84: 68 Motion Therapy, Continuous Passi
Page 85 and 86: 23 pentasaccharide*.mp. (2192) 24 e
Page 87 and 88: Appendix 1B: Review of search strat
Page 89 and 90: Question(s) Appendix 2: Phillips et
Page 91 and 92: Has the source for all costs been d
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