Electronic Supplementary material

Journal name: American Journal of Cardiovascular Drugs

Article title: Cost-effectiveness of apixaban versus warfarin or aspirin for
stroke prevention in patients with Atrial Fibrillation: a Greek perspective
All author names: Kostas Athanasakis, Nadia Boubouchairopoulou,
Eleftheria Karampli, Filippos Tarantilis, Paraskevi Savvari, Aikaterini Bilitou
and John Kyriopoulos
Affiliation and e-mail address of the corresponding author:
Aikaterini Bilitou, Pfizer Hellas,
Katerina.bilitou@pfizer.com

In the absence of any other source data such as registries or

medical databases available in Greece for the management of AF,
information on resource use was collected via an expert consensus
panel with healthcare practitioners (cardiologists and internists)
conducted by the National School of Public Health. This technique is
preferable over the Delphi method, as is less time-consuming and
enables the interaction between physicians, an element needed
especially for the validation of the patient management model, for
which no prior publication in the Greek environment existed.

The main objectives were:

to investigate the clinical management of AF patients in everyday
medical practice
to quantify the healthcare resources consumed per patient and
by therapeutic strategy
to quantify the total amount of resources used, by estimating the
proportion of patients consuming specific health services and
their corresponding frequency of consumption.
The expert panel included 10 leading physicians in cardiology and
internists who specialize in the clinical disease management of AF
representing different regions of Greece and healthcare settings i.e.
university clinics, NHS hospitals and clinics, private sector. A brief
literature review was conducted to identify data gaps and after
consulting with physicians with large experience in the management
of the disease, statisticians and scientists specialized in Health
Economics. a set of the main research interests in a semi-structured
questionnaire was formed. The questionnaire was then transcribed
into an electronic voting system to be used at the one-day panel.
Questions were presented to the experts and brief clarifications
were provided, when deemed necessary. The experts answered the
questions via a mobile numeric keyboard in a pre-determined time
frame of 15 seconds. Voting was anonymous. The results of the first
round of the voting were presented immediately to the experts in
the form of mean values and standard deviations. The experts
commented over the results and possible different opinions were
thoroughly discussed in order to achieve reconciliation towards the
mean values. The question was repeated and the result (mean value
and standard deviation) was presented and deemed as the final
answer of the panel.
Regarding the specific results of the resource use based upon which
the costs were estimated and used in the final paper are presented
in the tables S1-S4 below.

Table S1: Mean number of visits per year (per patient) by

treatment considered
Treatment Number of visits/year
Apixaban 2,63
Aspirin 1,63
Warfarin 5,86
Aspirin + Clopidogrel 2,63

Table S2: Mean number of visits per year for INR monitoring
by TTR value
Frequency of INR
Number of visits/year
monitoring
TTR < 52.38% 4,8
52.38% TTR < 66.02% 5,5
66.02% TTR < 76.51% 6,22
TTR 76.51% 7,44
Table S3: Proportion (%) of patients suffering from
gastrointestinal disorders by treatment received
Treatment Percentage
Apixaban 4,33
Aspirin 11,6
Warfarin 5,3
Clopidogrel 5,2

Table S4: Proportion (%) of patients in need of kidney

function monitoring during treatment (moderate or severe
renal impairment)
Treatment Percentage
Apixaban 100
Aspirin 52
Warfarin 55
Clopidogrel 48,5