Background. The cost-effectiveness analysis of therapeutic innovations has become a reference for decision makers in developed countries. When new treatments are available as alternatives to existing well established and cheap treatments, payers anticipate a major budget impact and will assess the extra benefit for society for extra Euros spent. Aims. This study aimed at presenting the different published results of cost-effectiveness analyses performed for the three first new oral anticoagulants, dabigatran, rivaroxaban and apixaban, for the prevention of strokes for patients with atrial fibrillation. The study covered European countries and Canada, which all propose universal coverage for healthcare expenditures. Methods. A literature review was performed. The general characteristics and main results of selected studies were presented and compared. Results. Nineteen studies were selected, covering 11 European countries and Canada. All studies have performed the estimation of a cost per QALY. The majority of the results (34/46) were under €20,000 per QALY. Apixaban and dabigatran 150mg bid presented with the most favourable results. Conclusion. New oral anticoagulants appear to have an acceptable cost-effectiveness ratio for European countries and Canada considering usual standards. Nevertheless, beyond intrinsic differences between healthcare systems, the observed variability of results strongly suggest a need for a standardisation of models used across countries.
PUYOU DE POUVOURVILLE, G. (2016). Anticoagulants d'action directe: une revue de la littérature des études coût/efficacité en Europe. Archives of Cardiovascular Diseases Supplements, 8(2), pp. 180-191.