Evidence map›Paper›PMID 24513791›Full record

ArticleEuropean heart journal2014

Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation.

Paul Dorian, Thitima Kongnakorn, Hemant Phatak, Dale A Rublee, Andreas Kuznik, Tereza Lanitis, Larry Z Liu, Uchenna Iloeje, Luis Hernandez, Gregory Y H Lip

Registry-linked trialOpen access · greenAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04357288 (Randomized Evaluation of Decision Support Interventions for Atrial Fibrillation), which is not on this map. Cited by 44 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 8 pooled it
11.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04357288 nacompletednot on this mapstarted 2020, after this paper: background citation

Randomized Evaluation of Decision Support Interventions for Atrial Fibrillation

TypeinterventionalSponsorUniversity of UtahRan2020 to 2024Enrolled1,117ConditionsAtrial FibrillationArmsPatient Decision Aid, Encounter Decision Aid
3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 8 syntheses or guidelines pooled it, 95 citations in OpenAlex.

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  8. Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Paul DorianUniversity of Toronto, St Michael's Hospital Toronto, Ontario, Canada dorianp@smh.ca.
Thitima KongnakornEvidera, Bangkok, Thailand.
Hemant PhatakBristol-Myers Squibb, Princeton, NJ, USA.
Dale A RubleePfizer, New York, NY, USA.
Andreas KuznikPfizer, New York, NY, USA.
Tereza LanitisEvidera, London, UK.
Larry Z LiuPfizer, New York, NY, USA Weill Medical College of Cornell University, New York, NY, USA.
Uchenna IloejeBristol-Myers Squibb, Princeton, NJ, USA.
Luis HernandezEvidera, Lexington, MA, USA.
Gregory Y H LipUniversity of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Bristol-Myers Squibb (United States) · USPfizer (United States) · USBirmingham City Hospital · GBEVRAZ (United Kingdom) · GBIthaka Harbors · USSt. Michael's Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsWarfarin, a vitamin K antagonist (VKA), has been the standard of care for stroke prevention in patients with atrial fibrillation (AF). Aspirin is recommended for low-risk patients and those unsuitable for warfarin. Apixaban is an oral anticoagulant that has demonstrated better efficacy than warfarin and aspirin in the ARISTOTLE and AVERROES studies, respectively, and causes less bleeding than warfarin. We evaluated the potential cost-effectiveness of apixaban against warfarin and aspirin from the perspective of the UK payer perspective. RESULTS AND

methodsA lifetime Markov model was developed to evaluate the pharmacoeconomic impact of apixaban compared with warfarin and aspirin in VKA suitable and VKA unsuitable patients, respectively. Clinical events considered in the model include ischaemic stroke, haemorrhagic stroke, intracranial haemorrhage, other major bleed, clinically relevant non-major bleed, myocardial infarction, cardiovascular hospitalization and treatment discontinuations; data from the ARISTOTLE and AVERROES trials and published mortality rates and event-related utility rates were used in the model. Apixaban was projected to increase life expectancy and quality-adjusted life years (QALYs) compared with warfarin and aspirin. These gains were expected to be achieved at a drug acquisition-related cost increase over lifetime. The estimated incremental cost-effectiveness ratio was £11 909 and £7196 per QALY gained with apixaban compared with warfarin and aspirin, respectively. Sensitivity analyses indicated that results were robust to a wide range of inputs.

conclusionsBased on randomized trial data, apixaban is a cost-effective alternative to warfarin and aspirin, in VKA suitable and VKA unsuitable patients with AF, respectively.

Indexed as

AgedAnticoagulantsAspirinAtrial FibrillationCost-Benefit AnalysisDrug CostsFactor Xa InhibitorsFemaleHemorrhageHospitalizationHumansMaleMarkov ChainsMiddle AgedMulticenter Studies as TopicPyrazolesAnticoagulantsapixabanAspirinFactor Xa InhibitorsPyrazolesPyridonesVitamin KWarfarinApixabanAspirinAtrial fibrillationCost-effectivenessStroke preventionVitamin K antagonist

Identifiers

PMID24513791
PMCPMC4104492
OpenAlexW2136804807

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.