ABSTRACT
Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina.
ABSTRACT
OBJECTIVE: To estimate the morbidity and mortality of pneumonia in adults over 50 years of age in Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela. METHODS: Local data sources were queried to estimate the number of hospitalized and outpatient pneumonia cases and deaths in the year 2009. Pneumonia cases were identified in adults aged ≥50 years using ICD-10 codes. The hospital case fatality rate (HCFR) by age corresponds to the percentage of mortality per hospitalization. RESULTS: Cases of hospitalized pneumonia (incidence per 100 000 inhabitants/year) in adults ≥50 years were: Argentina 39 674 (401.1); Brazil 225 341 (611.6); Chile 30 434 (738.5); Colombia 26 955 (326.6); Mexico 82 397 (413.1); Venezuela 31 601 (640.1). The number of hospital deaths (CFR%) were: Argentina 5099 (13%); Brazil 47 287 (21%); Chile 3072 (10%); Colombia 2981 (11%); Mexico 13 312 (16%); Venezuela 11 101 (35%). Cases of outpatient pneumonia (incidence per 100 000 inhabitants/year) were: Argentina 54 093 (546.8); Brazil 260 277 (706.4); Chile 33 173 (804.9); Colombia 27 713 (335.8); Mexico 83 354 (417.9); Venezuela 39 645 (803.0). The percentage of episodes treated as outpatient was 64% (range 57-80%) among those aged 50-64 years and 39% (range 8-56%) among those ≥85 years. Across countries, 51% of hospitalizations (range 42-63%) and 69% of deaths (range 65-72%) were in adults ≥75 years. CONCLUSIONS: Pneumonia is a common cause of hospitalization and mortality in adults in Latin America. Incidence increases substantially with increasing age, as does the likelihood of hospitalization and mortality.
