Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation

DSpace/Manakin Repository

Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation

Citable link to this page

 

 
Title: Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation
Author: Freeman, James V.; Zhu, Ruo P.; Owens, Douglas K.; Garber, Alan M; Hutton, David W.; Go, Alan S.; Wang, Paul J.; Turakhia, Mintu P.

Note: Order does not necessarily reflect citation order of authors.

Citation: Freeman, James V., Ruo P. Zhu, Douglas K. Owens, Alan M. Garber, David W. Hutton, Alan S. Go, Paul J. Wang, and Mintu P. Turakhia. 2011. Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Annals of Internal Medicine 154, 1:1-11.
Access Status: Full text of the requested work is not available in DASH at this time (“dark deposit”). For more information on dark deposits, see our FAQ.
Full Text & Related Files:
Abstract: Background: Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin.

Objective: To estimate the quality-adjusted survival, costs, and cost-effectiveness of dabigatran compared with adjusted-dose warfarin for preventing ischemic stroke in patients 65 years or older with nonvalvular AF.

Design: Markov decision model.

Data Sources: The RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial and other published studies of anticoagulation. The cost of dabigatran was estimated on the basis of pricing in the United Kingdom.

Target Population: Patients aged 65 years or older with nonvalvular AF and risk factors for stroke (\(CHADS_2\) score ≥1 or equivalent) and no contraindications to anticoagulation.

Time Horizon: Lifetime.

Perspective: Societal.

Intervention: Warfarin anticoagulation (target international normalized ratio, 2.0 to 3.0); dabigatran, 110 mg twice daily (low dose); and dabigatran, 150 mg twice daily (high dose).

Outcome Measures: Quality-adjusted life-years (QALYs), costs (in 2008 U.S. dollars), and incremental cost-effectiveness ratios.

Results of Base-Case Analysis: The quality-adjusted life expectancy was 10.28 QALYs with warfarin, 10.70 QALYs with low-dose dabigatran, and 10.84 QALYs with high-dose dabigatran. Total costs were $143 193 for warfarin, $164 576 for low-dose dabigatran, and $168 398 for high-dose dabigatran. The incremental cost-effectiveness ratios compared with warfarin were $51 229 per QALY for low-dose dabigatran and $45 372 per QALY for high-dose dabigatran.

Results of Sensitivity Analysis: The model was sensitive to the cost of dabigatran but was relatively insensitive to other model inputs. The incremental cost-effectiveness ratio increased to $50 000 per QALY at a cost of $13.70 per day for high-dose dabigatran but remained less than $85 000 per QALY over the full range of model inputs evaluated. The cost-effectiveness of high-dose dabigatran improved with increasing risk for stroke and intracranial hemorrhage.

Limitation: Event rates were largely derived from a single randomized clinical trial and extrapolated to a 35-year time frame from clinical trials with approximately 2-year follow-up.

Conclusion: In patients aged 65 years or older with nonvalvular AF at increased risk for stroke (\(CHADS_2\) score ≥1 or equivalent), dabigatran may be a cost-effective alternative to warfarin depending on pricing in the United States.

Primary Funding Source: American Heart Association and Veterans Affairs Health Services Research & Development Service.
Published Version: 10.7326/0003-4819-154-1-201101040-00289
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:11563386
Downloads of this work:

Show full Dublin Core record

This item appears in the following Collection(s)

 
 

Search DASH


Advanced Search
 
 

Submitters