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Andexanet Alfa (Ondexxya): CADTH Reimbursement Review: Therapeutic area: Reversal of FXa inhibitor anticoagulant effects [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2024 Mar.

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Andexanet Alfa (Ondexxya): CADTH Reimbursement Review: Therapeutic area: Reversal of FXa inhibitor anticoagulant effects [Internet].

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Table 5CADTH Revisions to the Submitted Economic Evaluation

Stepped analysis Sponsor’s value or assumption CADTH value or assumption
Corrections to sponsor’s base case
1. Acute care hospitalization costs by bleed site
  • ICH: $12,688
  • GI: $5,902
  • Other bleeds: $2,689
  • ICH: $11,374
  • GI: $5,291
  • Other bleeds: $2,411
2. Apixaban costUnit cost: $1.2252Unit cost: $0.4084
Changes to derive the CADTH base case
1. Equal mRS distributions for andexanet alfa and PCCThe sponsor assumed different mRS distributions between andexanet alfa and PCC, resulting in lower mRS states for patients using andexanet alfa.

Distribution of mRS scores for PCC:

  • 0 = 2.1%
  • 1 = 5.1%
  • 2 = 12.7%
  • 3 = 16.5%
  • 4 = 18.9%
  • 5 = 44.8%
Distribution of mRS scores for andexanet alfa:
  • 0 = 16.5%
  • 1 = 11.0%
  • 2 = 5.8%
  • 3 = 13.5%
  • 4 = 24.2%
  • 5 = 29.1%

Equal distribution to align with PCC.

Distribution of mRS scores for PCC and andexanet alfa:

  • 0 = 2.1%
  • 1 = 5.1%
  • 2 = 12.7%
  • 3 = 16.5%
  • 4 = 18.9%
  • 5 = 44.8%

2. Equal ICH long-term utilities for andexanet alfa and PCCSponsor assumed different mRS distributions between andexanet alfa and PCC would result in varying long-term utilities for the ICH survivor andexanet alfa health state.
  • Long-term utility for PCC: 0.62
  • Long-term utility for andexanet alfa by mRS score:
    • 0 = 0.79
    • 1 = 0.74
    • 2 = 0.64
    • 3 = 0.45
    • 4 = 0.24
    • o 5 = 0.09
  • Equal long-term utilities at baseline
  • Long-term utility for PCC and andexanet alfa: 0.62
CADTH base case—Reanalysis 1 + 2

GI = gastrointestinal; ICH = intracranial hemorrhage; mRS = modified Rankin Scale; PCC = prothrombin complex concentrate.

From: Pharmacoeconomic Review

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Copyright © 2024 - Canadian Agency for Drugs and Technologies in Health. Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND).

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