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All Journal Farmasains : Jurnal Farmasi dan Ilmu Kesehatan Jambi Medical Journal : Jurnal Kedokteran dan Kesehatan Jurnal Ilmu Kedokteran (Journal of Medical Science) Jurnal Kedokteran Brawijaya Pharmaciana: Jurnal Kefarmasian Media Farmasi : Jurnal Ilmu Farmasi (Journal Of Pharmaceutical Science) Althea Medical Journal Jurnal Farmasi Klinik Indonesia INDONESIAN JOURNAL OF PHARMACY MNJ (Malang Neurology Journal) Universa Medicina Berkala Ilmiah Kedokteran Duta Wacana Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Jurnal Ilmiah Ibnu Sina (JIIS): Ilmu Farmasi dan Kesehatan Majalah Farmaseutik Jurnal Ilmiah Ilmu Kesehatan: Wawasan Kesehatan JFIOnline Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education JURNAL FARMASI GALENIKA YARSI Medical Journal Majalah Kedokteran Neurosains Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal Kesehatan Cermin Dunia Kedokteran AKSONA Journal of Pain, Vertigo and Headache Pharmaceutical Sciences and Research (PSR) MEDICINUS Jurnal Farmasi Sains dan Praktis Berita Kedokteran Masyarakat Neurona Borneo Journal of Pharmacy Indonesian Journal of Pharmacology and Therapy Journal of Medicine and Health Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Rizaldy Pinzon
Fakultas Kedokteran Universitas Kristen Duta Wacana Yogyakarta
Biochemistry, Genetics & Molecular Biology Chemistry Dentistry Education Environmental Science Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Nursing Public Health

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Journal : INDONESIAN JOURNAL OF PHARMACY

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Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting Dwiprahasto, Iwan; Kristin, Erna; Endarti, Dwi; Pinzon, Rizaldy Taslim; Yasmina, Alfi; Thobari, Jarir At; Pratiwi, Woro Rukmi; Kartika, Yolanda Dyah; Trijayanti, Christiana
Indonesian Journal of Pharmacy Vol 30 No 1, 2019
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1127.563 KB) | DOI: 10.14499/indonesianjpharm30iss1pp74

Abstract

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin.
Co-Authors Adnyana, Kadek Sinthia Grahita Agung Endro Nugroho Agung Wiwiek Indrayani Agustinus Rudolf Phyma, Agustinus Rudolf Al Jody, Abraham Al Jody, Abraham Alexxander Alexxander, Alexxander Alfi Yasmina Alfi Yasmina Amboro, Wisnu Anak Agung Gede Sugianthara Angela, Angela Ardiani, Birgitta Lisbethiara Bagaskara, Arya T Basuki, Mudjiani Bisay, Vallentino Ardine Prasetya Budi Harsana, Mary Rose Angelina Bustami, Mursyid Ciptasari, Debora Purwasista Daniel Mahendra Krisna, Daniel Mahendra Desyandri Desyandri Digdoyo, Ananda Dodik Tugasworo Erna Kristin Esdras Ardi Pramudita, Esdras Ardi Fedora, Gusti Ayu Jacinda Amanda Ferdy Firmansyah Firdaus Hafidz As Shidieq Fithrie, Aida Fransiska Theresia Meivy Babang, Fransiska Theresia Meivy Gelgel, Putu Clara Shinta Hakim, Manfaluthy Hardi Astuti Witasari Hariatmoko Hariatmoko, Hariatmoko Hidayat, Muh. Faris I Putu Eka Widyadharma Ida Safitri Laksanawati Ika Puspitasari Iwan Dwiprahasto Jarir At Thobari Jesisca, Jesisca Johan Budiman, Johan Kadex Reisya Sita Damayanti Kriswanto Widyo, Kriswanto Kushartanti, Bernadeta Margareta Wara Lailla Affianti Fauzi Laksmi Asanti, Laksmi Lucas Meliala Maharani, Anyelir Dewi Maharani, Regina Vika Marpaung, Refianda Olivia Febrianti Mitasari, Pradita S Mugiono, Iroen Muhammad Hasnawi Haddani Muktiarini, Bernadetha Muslimah Muslimah Nani Kurniani Nathanael, Hanshel Everad Novita Intan Arovah Nugraha, Boya Padma, Radha Govinda Pagan Pambudi Pandita, Felicia Dara Puspitaning Paramitha, Dessy Pratiwi, Woro Rukmi Priskila, Loury Purwaka, Barlaam Bagus Purwaka Purwandityo, Ayuningtyas Galuh Purwantiningsih, Purwantiningsih Putra, I Dewa Gde Rainey Chrisananta Ratih Puspita Febrinasari Rendra, Andreas K. Renita Sanyasi, Rosa De Lima Renita Sanyasi, Rosa De Lima Renita, Rosa De Lima Rosa De Lima Renita Sanyasi, Rosa De Lima Renita Setyawan, Irfanianta Arif Sinaga, Ruth Vanessa Gloria Siti Nurhayati Sudharmadji Sugianto Sugianto s Sugianto Sugianto Susanto, Agnes Susi Susanti Sutejo, Mianti Nurrizky Thomas Eko Purwata Tri Murti Andayani Trijayanti, Christiana Vania Rau, Chiquita Putri Veronica, Vanessa Vidyatama, Veren Amoreta Widyantanti, Maria Atika Sukmana Wijaya, Vincent Ongko Wijono, Andre Dharmawan Wuysang, Audry Devisanty Y, Yudiyanta Yacobus Christian Prasetyo Yolanda Dyah Kartika Zalukhu, Marta Lisnawati