COST-EFFECTIVENESS OF APIXABAN VERSUS ACENOCOUMAROL FOR STROKE PREVENTION IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN ALGERIA
Author(s)
Yazid Aoudia1, jalal Atieh, bachelor of pharmacy2, Sabrina Belahnche, bachelor of pharmacy3, Imene Hana, Doctor of pharmacy3, Khader Al-Habash, Sr., PharmD2.
1Independent Consultant, Algeria, 2Market Access, Hikma Pharmaceuticals, Amman, Jordan, 3Market Access, hikma Pharmaceuticals, Algiers, Algeria.
1Independent Consultant, Algeria, 2Market Access, Hikma Pharmaceuticals, Amman, Jordan, 3Market Access, hikma Pharmaceuticals, Algiers, Algeria.
OBJECTIVES: European Society of Cardiology recommends using direct oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation (NVAF); however, vitamin-K antagonists remain commonly used. In Algeria, acenocoumarol the standard-of-care anticoagulant option. This study evaluated the cost-effectiveness of apixaban versus acenocoumarol for stroke prevention in patients with stable NVAF from the Algerian payer perspective.
METHODS: A lifetime Markov model followed by a decision tree was developed to estimate clinical and economic outcomes for patients with stable NVAF. The model included 9 health states, including ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleeding, clinically relevant non-major bleeding, myocardial infarction, cardiovascular hospitalization, treatment discontinuation, and death. Clinical event rates were derived mainly from the AVERROES and the ARISTOTLE trials, Clinical events rates were adjusted over time according ageing. Algerian cost inputs were used where available. Costs and health outcomes were discounted at 3.5% annually. Probabilistic and deterministic sensitivity analysis was done
RESULTS: Over the lifetime horizon, patients treated with apixaban achieved 10.3 life-years (LYs) and 7.34 quality-adjusted life year (QALYs), compared with 10.0 life-years and 7.08 QALYs for acenocoumarol. This resulted in incremental gains of 0.29 LYs and 0.26 QALYs. Apixaban was associated with reductions in cardiovascular and bleeding-related costs of 972,607 DZD compared with 1,018,476 DZD for acenocoumaro. The incremental total cost of apixaban was 119,993 DZD, resulting in an ICER of 483,075 DZD per QALY gained. This ICER was below one Algerian gross domestic product per capita, at 767,066 DZD.
CONCLUSIONS: From Algerian payer perspective, apixaban improves quality-adjusted survival compared with acenocoumarol in patients with stable NVAF. Although apixaban was associated with higher drug acquisition costs, these were partially offset by reductions in cardiovascular and bleeding-related costs. The resulting ICER was below one GDP per capita, indicating that apixaban represents a cost-effective anticoagulation option for patients with NVAF in Algeria.
METHODS: A lifetime Markov model followed by a decision tree was developed to estimate clinical and economic outcomes for patients with stable NVAF. The model included 9 health states, including ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleeding, clinically relevant non-major bleeding, myocardial infarction, cardiovascular hospitalization, treatment discontinuation, and death. Clinical event rates were derived mainly from the AVERROES and the ARISTOTLE trials, Clinical events rates were adjusted over time according ageing. Algerian cost inputs were used where available. Costs and health outcomes were discounted at 3.5% annually. Probabilistic and deterministic sensitivity analysis was done
RESULTS: Over the lifetime horizon, patients treated with apixaban achieved 10.3 life-years (LYs) and 7.34 quality-adjusted life year (QALYs), compared with 10.0 life-years and 7.08 QALYs for acenocoumarol. This resulted in incremental gains of 0.29 LYs and 0.26 QALYs. Apixaban was associated with reductions in cardiovascular and bleeding-related costs of 972,607 DZD compared with 1,018,476 DZD for acenocoumaro. The incremental total cost of apixaban was 119,993 DZD, resulting in an ICER of 483,075 DZD per QALY gained. This ICER was below one Algerian gross domestic product per capita, at 767,066 DZD.
CONCLUSIONS: From Algerian payer perspective, apixaban improves quality-adjusted survival compared with acenocoumarol in patients with stable NVAF. Although apixaban was associated with higher drug acquisition costs, these were partially offset by reductions in cardiovascular and bleeding-related costs. The resulting ICER was below one GDP per capita, indicating that apixaban represents a cost-effective anticoagulation option for patients with NVAF in Algeria.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE316
Topic
Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)