Cost-Effectiveness of Dabigatran Etexilate for the Prevention of Stroke and Systemic Embolism in UK Patients With Atrial Fibrillation

Apr 12, 2012
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Authors:
Kansal AR, Sorensen SV, Gani R, et al.
Citation:
Heart 2012;98:573-578.
Summary By:
Fred Morady, MD, FACC

Study Questions:

How cost-effective is dabigatran compared to warfarin, aspirin, or no therapy in patients with atrial fibrillation (AF)?

Methods:

The cost-effectiveness of dabigatran was determined using a Markov model. The dabigatran dose used in the model was 150 mg twice daily until age 80, then 110 mg twice daily. In the warfarin group, the international normalized ratio was assumed to be in therapeutic range (2-3) 64% of the time, consistent with trial data. Estimates of major clinical events were based on data from published trials and meta-analyses. Cost-effectiveness was expressed as incremental cost per quality-adjusted year of life (QALY) gained.

Results:

The increase in QALYs was higher with dabigatran (8.06) than warfarin (7.82). The lifetime cost per patient for disease management also was higher with dabigatran (£19,645) than warfarin (£18,474). Aspirin provided 7.59 QALYs and was associated with a management cost of £18,561. The largest management cost (£20,475) was incurred by no therapy. The incremental cost-effectiveness ratio (ICER) of dabigatran compared to warfarin was £4,831/QALY gained in patients under the age of 80 years and £7,090/QALY gained over the age of 80 years. Under the age of 80 years, the ICER of dabigatran compared to aspirin was £3,457/QALY gained. Dabigatran was both more effective and less costly than no therapy.

Conclusions:

The authors concluded that dabigatran is cost-effective in patients with AF.

Perspective:

The benchmark for acceptable cost-effectiveness is £20,000/QALY gained. Therefore, the results of this study suggest that the cost-effectiveness of dabigatran is quite reasonable. The favorable cost-effectiveness of dabigatran despite its higher cost is attributable to an anticipated reduction in major adverse clinical events and in long-term disability from catastrophic events.

Keywords: Stroke, Benzimidazoles, Cardiology, Warfarin, Costs and Cost Analysis, Atrial Fibrillation, Pyridines, Embolism


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