One-way?and probabilistic sensitivity analyses (PSA) were used to assess the robustness of the results. Results Results from the meta-analysis showed that apixaban had a high probability of being the most effective for stroke/SE, MB and ACM. up of data from your literature and a meta-analysis of RWE around JLK 6 the incidence of stroke/systemic embolism (SE), major bleeding (MB), intracranial haemorrhage (ICH) and all-cause mortality (ACM); direct costs included drug costs, costs for drug monitoring, and management of events from official national lists. One-way?and probabilistic sensitivity analyses (PSA) were used to assess the robustness of the results. Results Results from the meta-analysis showed that apixaban experienced a high probability of being the most effective for stroke/SE, MB and ACM. Despite their higher acquisition costs, the cost-effectiveness analysis showed all DOACs involved a saving when compared with VKAs, with per-patient savings ranging between 4647 (rivaroxaban) to 6086 (apixaban). Moreover, all DOACs indicated a gain both in quality-adjusted life-years and life-years. According to PSA, findings related to apixaban were consistent, while for dabigatran and rivaroxaban PSA revealed a higher degree of uncertainty. Conclusions The beneficial JLK 6 effect of DOACs on made up of events showed in RWE experienced the potential to offset drug-related costs, thus improving the sustainability JLK 6 of treatment for non-valvular AF in daily clinical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-021-01002-z. Key Points Sufficient evidence is now available to inform a cost-effectiveness analysis of direct non-vitamin K oral anticoagulants (DOACs) for the management of atrial fibrillation on the basis of real-word evidence.Synthetizing available real-world evidence studies, apixaban, dabigatran and rivaroxaban were likely to improve health benefit over warfarin.Despite the higher acquisition costs, apixaban was cost-effective compared to warfarin, suggesting savings for the Italian National Health System; considerable uncertainty still remained around the cost-effectiveness of dabigatran and rivaroxaban. Open in a separate window Introduction Atrial fibrillation (AF) is the most common and clinically significant arrhythmia, and one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity in the world; it also carries a significant cost burden as a result of treatment and frequent hospitalization as well as Rabbit polyclonal to ZNF624.Zinc-finger proteins contain DNA-binding domains and have a wide variety of functions, mostof which encompass some form of transcriptional activation or repression. The majority ofzinc-finger proteins contain a Krppel-type DNA binding domain and a KRAB domain, which isthought to interact with KAP1, thereby recruiting histone modifying proteins. Zinc finger protein624 (ZNF624) is a 739 amino acid member of the Krppel C2H2-type zinc-finger protein family.Localized to the nucleus, ZNF624 contains 21 C2H2-type zinc fingers through which it is thought tobe involved in DNA-binding and transcriptional regulation considerable impairment in quality of life (QoL) [1, 2]. According to published data, about 33 million people suffer from AF [3]. A recent study also highlights wide variability in the prevalence of AF worldwide with significant gender differences. Specifically, estimates for 2010 2010 suggested an overall (age-adjusted) prevalence of AF of about 6.0 (95% confidence interval (CI) 5.6C6.4) per 1000 among men and 3.7 (95% CI 3.5C4.0) per 1000 among women; these figures were slightly higher in industrialized countries (compared to developing countries) being, respectively, 6.6 (95% CI 6.0C7.4) per 1000 among men and 3.9 (95% CI 3.4C4.5) per 1000 among women. Moreover, the USA and Canada showed the highest prevalence, while central and northern Europe, as well as India, Japan and China experienced the lowest rates, with data from eastern countries likely to be underestimated [1, 3]. Several studies JLK 6 suggested an increasing pattern in the prevalence and incidence of AF in the last decades; that course could partially be explained by the aging population and JLK 6 the increasing prevalence of co-morbidities and cardiovascular risk factors, in addition to other factors such as lifestyle changes and improved diagnosis [1, 3]. Management of patients with AF requires an integrated approach to monitor and control the disease, but also to prevent disease burden. Stroke prevention is crucial in AF patients, and the use of oral anticoagulants has been demonstrated to reduce the risk of events and also?to decrease mortality [4C6]; indeed, the 2016 European Society of Cardiology (ESC) guidelines for AF recommend the use of oral anticoagulants in all patients with CHA2DS2-VASC risk factors ?2 [7]. At present vitamin K antagonists (VKAs; i.e., warfarin) and four diverse non-vitamin K oral anticoagulants (DOACs)apixaban, dabigatran, rivaroxaban and edoxabanare available on the market, and can.