Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation.

Abstract

BACKGROUND:

Recent studies have investigated alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation (AF), but whether these alternatives are cost-effective is unknown.

METHODS AND RESULTS:

On the basis of the results from Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) and other trials, we developed a decision-analysis model to compare the cost and quality-adjusted survival of various antithrombotic therapies. We ran our Markov model in a hypothetical cohort of 70-year-old patients with AF using a cost-effectiveness threshold of $50 000/quality-adjusted life-year. We estimated the cost of dabigatran as US $9 a day. For a patient with an average risk of major hemorrhage (≈3%/y), the most cost-effective therapy depended on stroke risk. For patients with the lowest stroke rate (CHADS2 stroke score of 0), only aspirin was cost-effective. For patients with a moderate stroke rate (CHADS2 score of 1 or 2), warfarin was cost-effective unless the risk of hemorrhage was high or quality of international normalized ratio control was poor (time in the therapeutic range <57.1%). For patients with a high stroke risk (CHADS(2) stroke score ≥3), dabigatran 150 mg (twice daily) was cost-effective unless international normalized ratio control was excellent (time in the therapeutic range >72.6%). Neither dabigatran 110 mg nor dual therapy (aspirin and clopidogrel) was cost-effective.

CONCLUSIONS:

Dabigatran 150 mg (twice daily) was cost-effective in AF populations at high risk of hemorrhage or high risk of stroke unless international normalized ratio control with warfarin was excellent. Warfarin was cost-effective in moderate-risk AF populations unless international normalized ratio control was poor.

• Authors: Shimoli V Shah, Brian F Gage
• Journal: Circulation (Circulation) Vol. 123 Issue 22 Pg. 2562-70 (Jun 07 2011) ISSN: 1524-4539 [Electronic] United States
• PMID: 21606397 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Benzimidazoles
• beta-Alanine
• Warfarin
• Dabigatran

Topics

• Aged
• Anticoagulants (adverse effects, economics, therapeutic use)
• Atrial Fibrillation (complications, drug therapy, economics)
• Benzimidazoles (adverse effects, economics, therapeutic use)
• Cohort Studies
• Cost-Benefit Analysis (methods)
• Dabigatran
• Decision Trees
• Hemorrhage (chemically induced, economics)
• Humans
• Markov Chains
• Risk Factors
• Stroke (economics, prevention & control)
• Warfarin (adverse effects, economics, therapeutic use)
• beta-Alanine (adverse effects, analogs & derivatives, economics, therapeutic use)