Cost-effectiveness of andexanet alfa versus four-factor prothrombin complex concentrate for the treatment of oral factor Xa inhibitor-related intracranial hemorrhage in the US. (31st December 2022)

• Record Type: Journal Article
• Authors: Fanikos, John; Goldstein, Joshua N.; Lovelace, Belinda; Beaubrun, Anne C.; Blissett, Robert S.; Aragão, Filipa
• Is Part Of: Journal of medical economics. Volume 25:Number 1(2022)
• Page Start: 309
• Page End: 320
• Publication Date: 2022-12-31
• Subjects: Andexanet alfa -- cost-effectiveness analysis -- factor Xa inhibitor -- intracranial hemorrhage; I00 -- I -- I10 -- I1 -- I -- I11; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2022.2042106
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aim: To conduct a cost-effectiveness analysis (CEA) on the use of andexanet alfa for the treatment of factor Xa inhibitor-related intracranial hemorrhage (ICH) from the US third-party payer and societal perspectives. Methods: CEA compared andexanet alfa to prothrombin complex concentrate for the treatment of patients receiving factor Xa inhibitors admitted to hospital inpatient care with an ICH. The model comprised two linked phases. Phase 1 utilized a decision tree to model the acute treatment phase (admission of a patient with ICH into intensive care for the first 30 days). Phase 2 modeled long-term costs and outcomes using three linked Markov models comprising the six health states defined by the modified Rankin score. Results: The analysis showed that the strategy of using andexanet alfa for the treatment of factor Xa inhibitor-related ICH is cost-effective, with incremental cost-effectiveness per quality-adjusted life-year gained of $35, 872 from a third-party payer perspective and $40, 997 from a societal perspective over 20 years. Limitations: (1) Absence of head-to-head trials comparing therapies included in the economic model, (2) lack of comparative long-term data on treatment efficacy, and (3) bias resulting from the study designs of published literature. Conclusion: Given these results, the use of andexanet alfa for the reversal of anticoagulation in patients with factor Xa inhibitor-related ICH may improve quality of life and is likely to be cost-effective in a US context.