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Comparative and Cost-effectiveness o...

Tawfik, Amy.

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Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs./
Author:	Tawfik, Amy.
Description:	141 p.
Notes:	Source: Dissertation Abstracts International, Volume: 77-07(E), Section: B.
Contained By:	Dissertation Abstracts International77-07B(E).
Subject:	Pharmaceutical sciences. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10017884
ISBN:	9781339505640

Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs.
Tawfik, Amy.

Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs. - 141 p.

Source: Dissertation Abstracts International, Volume: 77-07(E), Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2015.

Objectives: To develop a state-transition model evaluating the cost-effectiveness of all antithrombotic treatments for atrial fibrillation (AF) patients, at varying risks for stroke and bleeding, and to generate high-quality effectiveness and cost data to inform the model.

ISBN: 9781339505640Subjects--Topical Terms:

3173021
Pharmaceutical sciences.

Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs.
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100 1 $a Tawfik, Amy. $3 3192616
245 1 0 $a Comparative and Cost-effectiveness of Stroke Prevention Treatments in Atrial Fibrillation: A New Generation of Drugs.
300 $a 141 p.
500 $a Source: Dissertation Abstracts International, Volume: 77-07(E), Section: B.
500 $a Adviser: Murray Krahn.
502 $a Thesis (Ph.D.)--University of Toronto (Canada), 2015.
520 $a Objectives: To develop a state-transition model evaluating the cost-effectiveness of all antithrombotic treatments for atrial fibrillation (AF) patients, at varying risks for stroke and bleeding, and to generate high-quality effectiveness and cost data to inform the model.
520 $a Methods: Bayesian network meta-analyses (NMA) were conducted to determine the comparative effectiveness of the following treatments: no treatment, aspirin, aspirin+clopidogrel, warfarin, dabigatran (110mg and 150mg), rivaroxaban, apixaban, and edoxaban (low-dose [LD] and high-dose). Cost data were generated from a cohort of real-world AF patients identified through administrative data, to estimate the costs associated with clinical events corresponding to health states in a state-transition model. The resulting model evaluated the cost-effectiveness of treatments in patients at varying CHADS2 and HAS-BLED scores. Patients were stratified into six risk groups, denoted as stroke/bleeding risk. The analysis was undertaken from the Canadian payer perspective using a lifetime horizon. Cost-effectiveness was measured in quality-adjusted life-years (QALYs) using the net health benefit (NHB) framework.
520 $a Results: At a willingness-to-pay of $50,000/QALY, the most cost-effective strategy was edoxaban LD for patients in all groups, except those at Moderate/Low and High/Low risk, for which apixaban was more cost-effective. The incremental NHBs (INHBs) of the first and second most cost-effective strategies for each group are presented. The INHBs of edoxaban LD versus apixaban were: Low/Low=0.01 QALYs, Moderate/Low= -0.03 QALYs, Low/High=0.25 QALYs, Moderate/High=0.21 QALYs, and High/High= 0.10 QALYs. The INHB of apixaban versus dabigatran 150mg in patients in the High/Low risk group was 0.06 QALYs. The model was sensitive to variations in the cost of edoxaban. For each group, the optimal strategy was cost-effective in 50% or less of the simulations.
520 $a Discussion and Conclusion: Depending on a patient's risk for stroke and bleeding, the most effective and cost-effective strategy is dabigatran 150mg, apixaban or edoxaban LD. This thesis serves as the first economic evaluation of antithrombotic treatment in AF to include an original NMA and costing study. We have produced a robust economic evaluation, based on high-quality effectiveness and cost data that can inform future economic evaluations, and provided an example of how to employ best practices when conducting them.
590 $a School code: 0779.
650 4 $a Pharmaceutical sciences. $3 3173021
690 $a 0572
710 2 $a University of Toronto (Canada). $b Pharmaceutical Sciences. $3 3170825
773 0 $t Dissertation Abstracts International $g 77-07B(E).
790 $a 0779
791 $a Ph.D.
792 $a 2015
793 $a English
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10017884