Surviving patients enter the long-term model, which consists of 6 health states defined by their modified Rankin Score (mRS) at 30 days post ICH. New technology add-on payments (NTAP) were included as an offset against pharmacy costs for andexanet alfa. Drug costs, cost of ICU days, intubation, and surgical costs were included. In the acute phase, patients entering the model encounter 4 sequential probability nodes representing the risk of hematoma expansion (≥33% volume increase from baseline), mechanical ventilation, neurosurgical intervention, and death, respectively. Methods: A cost utility model comprising two interlinked phases was developed from a USA payer perspective: in the first, a decision tree structure models the acute care episode from hospital admission to 30 days, while in phase 2 a cohort state transition structure models the long term. In this study a decision analytic cost utility model was developed to estimate the cost effectiveness of using andexanet alfa compared to prothrombin complex concentrates (PCCs) to treat intracranial hemorrhage (ICH) associated with DOAC-related bleeds. Andexanet alfa, a modified recombinant inactive form of human FXa, is a specific reversal agent for rivaroxaban and apixaban. Purpose: Direct oral anticoagulants (DOAC) such as apixaban and rivaroxaban are safe and effective in the treatment and prevention of thrombotic events, but remain a cause of major bleeding events, which are associated with considerable morbidity and mortality.
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