ArticlePloS one2014
Economic evaluation of apixaban for the prevention of stroke in non-valvular atrial fibrillation in the Netherlands.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 4 of them syntheses that pooled it.
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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.
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.
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Who cites it
15 citing papers in PubMed, 4 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Factors influencing the cost-effectiveness of novel oral anticoagulants compared to vitamin K antagonists in patients with atrial fibrillation: a systematic review.Frontiers in pharmacology · 2025Pooled it
- Methods for Economic Evaluations of Novel Oral Anticoagulants in Patients with Atrial Fibrillation: A Systematic Review.Applied health economics and health policy · 2024Pooled it
- Economic evaluation of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation: a systematic review and meta-analysis.BMJ evidence-based medicine · 2022Pooled it
- Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review.PloS one · 2019Pooled it
- Cost-effectiveness of implementing a genotype-guided de-escalation strategy in patients with acute coronary syndrome.European heart journal. Cardiovascular pharmacotherapy · 2025Observational
- Cost-Effectiveness and Budget Impact Analysis of Apixaban and Rivaroxaban Versus Warfarin in the Prevention of Stroke in Patients With Non-Valvular Atrial Fibrillation (NVAF) in Iran.Clinical cardiology · 2024Article
- Cost-Minimization Model in Cryptogenic Stroke: ePatch vs Implantable Loop Recorder in Patients from the UK, Netherlands, and Sweden.Medical devices (Auckland, N.Z.) · 2024Article
- Budget and health impact of switching eligible patients with atrial fibrillation to lower- dose dabigatran.Journal of market access & health policy · 2023Article
- Cost-effectiveness of clopidogrel vs. ticagrelor in patients of 70 years or older with non-ST-elevation acute coronary syndrome.European heart journal. Cardiovascular pharmacotherapy · 2022Article
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- Extended Treatment with Apixaban for Venous Thromboembolism Prevention in the Netherlands: Clinical and Economic Effects.TH open : companion journal to thrombosis and haemostasis · 2018Article
- A Systematic Literature Review on the Cost-Effectiveness of Apixaban for Stroke Prevention in Non-valvular Atrial Fibrillation.Cardiology and therapy · 2016Article
- Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis.Therapeutic advances in neurological disorders · 2016Article
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Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStroke prevention is the main goal of treating patients with atrial fibrillation (AF). Vitamin-K antagonists (VKAs) present an effective treatment in stroke prevention, however, the risk of bleeding and the requirement for regular coagulation monitoring are limiting their use. Apixaban is a novel oral anticoagulant associated with significantly lower hazard rates for stroke, major bleedings and treatment discontinuations, compared to VKAs.
objectiveTo estimate the cost-effectiveness of apixaban compared to VKAs in non-valvular AF patients in the Netherlands.
methodsPreviously published lifetime Markov model using efficacy data from the ARISTOTLE and the AVERROES trial was modified to reflect the use of oral anticoagulants in the Netherlands. Dutch specific costs, baseline population stroke risk and coagulation monitoring levels were incorporated. Univariate, probabilistic sensitivity and scenario analyses on the impact of different coagulation monitoring levels were performed on the incremental cost-effectiveness ratio (ICER).
resultsTreatment with apixaban compared to VKAs resulted in an ICER of €10,576 per quality adjusted life year (QALY). Those findings correspond with lower number of strokes and bleedings associated with the use of apixaban compared to VKAs. Univariate sensitivity analyses revealed model sensitivity to the absolute stroke risk with apixaban and treatment discontinuations risks with apixaban and VKAs. The probability that apixaban is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 68%. Results of the scenario analyses on the impact of different coagulation monitoring levels were quite robust.
conclusionsIn patients with non-valvular AF, apixaban is likely to be a cost-effective alternative to VKAs in the Netherlands.
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Registered trials
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