Key result
Non-vitamin K oral anticoagulants were recommended over warfarin for non-valvular atrial fibrillation by most health technology assessment agencies, including apixaban in 83% and rivaroxaban in 76% of countries.
Why the study?
To assess global health technology assessment reports and recommendations regarding non-vitamin K oral anticoagulants in non-valvular atrial fibrillation.
Global health technology assessments generally recommend NOACs over warfarin for NVAF, though specific NOAC recommendations vary based on local willingness-to-pay thresholds.
BACKGROUND: This review assessed global health technology assessment (HTA) reports and recommendations of non-vitamin K oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF). METHODS: NHTA agency websites were searched for HTA reports evaluating NOACs versus NOACs or vitamin K antagonists. HTA methods and information on patient involvement/access were collected and empirically analyzed. RESULTS: The review identified 38 unique HTA reports published between 2012 and 2017 in 16 countries including 11 in Europe. NOACs that were cost-effective per local willingness-to-pay (WTP) thresholds were positively recommended for the treatment of NVAF. WTP thresholds ranged from €20,000 to 69,000. Apixaban was recommended in 10/12 (83%) countries, dabigatran in 9/13 (69%) countries, and rivaroxaban in 10/13 (76%) over warfarin. Edoxaban was recommended in 5/7 (71%) countries. Economic evaluations and recommendations comparing NOACs were sparse (two or three countries per NOAC) and generally favored apixaban and edoxaban, followed by dabigatran. Eleven HTA reports from four countries considered the patient voice (Canada [n = 3], Scotland [n = 3], England [n = 4], Brazil [n = 1]); however, only 2/11 (18%) developed recommendations based on this. Among the reports with a positive recommendation, 26/30 (87%) featured a decision that aligned with the approved regulatory label. CONCLUSIONS: Most agencies recommended NOACs over warfarin for patients with NVAF. Few countries made statements recommending one NOAC over another. Given different WTP thresholds, a drug that is cost-effective in one market may not be in another. Therefore, the various NOAC recommendations from HTA agencies cannot be generalized across different countries.
No takes yet. Share an insight, caveat, or question.
Lópes et al. (2020) conducted a review in Non-valvular atrial fibrillation (n=38). Non-vitamin K oral anticoagulants (NOACs) vs. Vitamin K antagonists or other NOACs was evaluated on Health technology assessment recommendations and cost-effectiveness. Non-vitamin K oral anticoagulants were recommended over warfarin for non-valvular atrial fibrillation by most health technology assessment agencies, including apixaban in 83% and rivaroxaban in 76% of countries.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: