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Edoxaban (Lixiana) [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Apr.

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Edoxaban (Lixiana) [Internet].

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ABBREVIATIONS

AF

atrial fibrillation

CDR

CADTH Common Drug Review

CHADS2

congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and prior stroke or transient ischemic attack or thromboembolism

HS

hemorrhagic stroke

ICH

intracranial hemorrhage

IS

ischemic stroke

MI

myocardial infarction

NOAC

new oral anticoagulant

QALY

quality-adjusted life-year

SEE

systemic embolic event

TIA

transient ischemic attack

Table 1Summary of the Manufacturer’s Economic Submission

Drug productEdoxaban (Lixiana)
Study questionWhat is the cost-effectiveness of edoxaban 60 mg (30 mg dose reduced) compared with warfarin and other NOACs for the prevention of stroke and SEEs in patients with NVAF?
Type of economic evaluationCost-utility analysis
Target populationNVAF patients requiring chronic anticoagulation (i.e., CHADS2 ≥ 2)
TreatmentEdoxaban 60 mg (30 mg dose reduced) daily
OutcomeQALYs
Comparator(s)Primary analysis
Warfarin
Rivaroxaban 20 mg daily
Secondary analysis
Apixaban 5 mg b.i.d.
Dabigatran 110 mg b.i.d.
Dabigatran 150 mg b.i.d.
PerspectivePublicly funded health care system
Time horizonLifetime (36 years)
Results for base case
  • Incremental cost per QALY gained for edoxaban versus warfarin is $12,672.
  • Edoxaban dominates rivaroxaban (less costly and more effective).
Key limitations
  • Analysis limited to AF patients with CHADS2 ≥ 2 (i.e., CHADS2 = 1 excluded).
  • Results highlighted only for comparison with warfarin and rivaroxaban. As apixaban and dabigatran are also relevant comparators, a single sequential analysis should have been performed of all currently available alternatives for NVAF.
CDR estimate(s)The model structure and data inputs were considered appropriate; however, apixaban and dabigatran were not considered as comparators. Therefore, CDR performed a sequential comparison of all alternatives (warfarin, edoxaban, and other NOACs) on the basis of the submitted model design, using relative effects from the manufacturer-submitted NMA.
  • Apixaban was dominant (less costly, more effective) compared with all NOACs, including edoxaban, in this analysis.
  • The incremental cost per QALY gained for edoxaban versus warfarin was $8,184.
  • Other than apixaban, only dabigatran 150 mg was more effective in terms of total QALYs than edoxaban; the incremental cost per QALY gained for dabigatran 150 mg versus edoxaban was $4,182.
Probabilistic analysis showed that apixaban had the highest probability (55%) of being the optimal strategy at a threshold of $50,000 per QALY; edoxaban had a probability of 6.4%.

AF = atrial fibrillation; b.i.d. = twice daily; CHADS2 = congestive heart failure, hypertension, age = 75 years, diabetes mellitus, and prior stroke or TIA or thromboembolism; CDR = CADTH Common Drug Review; NMA = network meta-analysis; NOAC = new oral anticoagulant; NVAF = nonvalvular atrial fibrillation; QALY = quality adjusted life-year; SEE = systemic embolic event; TIA = transient ischemic attack.

Copyright © CADTH 2017.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK475907
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