Objective: Despite the beneficial effects of DOACs, suboptimal adherence is widely documented, and real-world adherence is lower than in clinical trials. The objective of this study is to compare the cost-effectiveness of apixaban versus rivaroxaban for stroke prevention by incorporating real-world adherence from the US payer's perspective.
Methods: We developed a Markov model with three health states to evaluate the total costs and quality-adjusted life years (QALY) at a willingness to pay threshold of $100,000. The population was a hypothetical cohort of 65-year-old patients with moderate to high stroke risk. The transition probabilities of healthy adherent, nonadherent, and stroke were obtained from a Medicare Advantage Plan. The utilities and costs were obtained from prior clinical studies. Deterministic and probabilistic sensitivity analyses were conducted.
Results: Apixaban was cost-effective than rivaroxaban at a willingness to pay threshold of $100,000. Apixaban yielded an additional 0.12 QALYs at a cost of $1904.39, resulting in an incremental cost-effectiveness ratio (ICER) of $16,279.25 per QALY gained. The Monte Carlo simulations indicated that apixaban was cost-effective at 89.67% of simulations. The ICER results were impacted by the medical costs among nonadherent patients.
Conclusion: After incorporating adherence, apixaban 5 mg was a cost-effective alternative to rivaroxaban 20 mg for stroke prevention among elderly atrial fibrillation (AF) patients.
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http://dx.doi.org/10.1080/14737167.2024.2398487 | DOI Listing |
Alzheimers Dement
December 2024
IPSIBAT (CONICET/National University of Mar del Plata), Mar del Plata, Buenos Aires, Argentina.
Background: In 2020, we developed LABPSI, a cognitive stimulation web lab. Usability analysis in MCI and healthy participants have already been studied, and currently, we performed it with acquired brain injuries (ABI) participants, as they can rehabilitate their cognitive symptoms and prevent the progression to dementia. Usability can be considered the ease of use of a certain product for a specific aim by a particular population.
View Article and Find Full Text PDFStroke
January 2025
Population Health Research Institute, University of British Columbia, Vancouver, Canada. (M.A.S., J.W.E., A.H.K., A. Shoamanesh, A.T., R.G.H., A.C., R.Z.).
Background: Stroke secondary to intracranial atherosclerotic disease (ICAD) is associated with high recurrence risk despite currently available secondary prevention strategies. In patients with systemic atherosclerosis, a significant reduction of stroke risk with no increase in intracranial or fatal hemorrhage was seen when rivaroxaban 2.5 mg twice daily was added to aspirin.
View Article and Find Full Text PDFEur Stroke J
January 2025
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
Introduction: The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducted a sub-analysis of the RAF and RAF-NOAC studies to evaluate the efficacy and safety of statins in secondary prevention in patients with acute ischemic stroke and AF.
View Article and Find Full Text PDFJ Rural Med
January 2025
Department of Applied Bioresource Science, The United Graduate School of Agricultural Sciences, Ehime University, Japan.
Objective: This study aimed to elucidate the relationship between daily eating habits and stroke risk factors in O City, Ehime Prefecture, Japan, using stroke registry data collected over a 26-year follow-up period based on standardized national criteria.
Materials And Methods: Overall, 1,793 middle-aged Japanese participants (446 men and 1,347 women) who completed a 33-item Food Frequency Questionnaire (FFQ) and had no history of stroke were matched to those from O City in a stroke registry from 1996 to 2022. Stroke diagnosis for each person was used to determine whether this was their first documented stroke, and we classified strokes as either a cerebral infarction (CI) or a hemorrhagic stroke (HS), the latter which included an intracerebral hemorrhage (ICH) or a subarachnoid hemorrhage (SAH).
Cureus
December 2024
Department of Rehabilitation, Musashigaoka Hospital, Kumamoto, JPN.
Gait asymmetry in post-stroke patients is an important gait characteristic that is associated with their balance control, inefficiency, and risks of musculoskeletal injury to the non-paretic lower limb and falling. Unfortunately, most stroke patients retain an asymmetrical gait pattern, even though their gait independence and gait speed improve. We describe the clinical course of a subacute stroke patient who achieved a symmetrical gait at discharge after undergoing both gait training with orthoses and robot-assisted gait training from the early intervention phase.
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