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dc.contributor.authorFreeman, James V.
dc.contributor.authorZhu, Ruo P.
dc.contributor.authorOwens, Douglas K.
dc.contributor.authorGarber, Alan M
dc.contributor.authorHutton, David W.
dc.contributor.authorGo, Alan S.
dc.contributor.authorWang, Paul J.
dc.contributor.authorTurakhia, Mintu P.
dc.date.accessioned2014-01-21T21:45:09Z
dc.date.issued2011
dc.identifierQuick submit: 2013-12-21T20:42:27-05:00
dc.identifier.citationFreeman, 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.en_US
dc.identifier.issn0003-4819en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11563386
dc.description.abstractBackground: 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.en_US
dc.language.isoen_USen_US
dc.publisherAmerican College of Physiciansen_US
dc.relation.isversionof10.7326/0003-4819-154-1-201101040-00289en_US
dc.relation.isversionofhttp://annals.org/article.aspx?articleid=746681en_US
dash.licenseMETA_ONLY
dc.titleCost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillationen_US
dc.typeJournal Articleen_US
dc.date.updated2013-12-22T01:43:47Z
dc.description.versionVersion of Recorden_US
dc.rights.holderFreeman JV; Zhu RP; Owens DK; Garber AM; Hutton DW; Go AS; Wang PJ; Turakhia MP
dc.relation.journalAnnals of Internal Medicineen_US
dash.depositing.authorGarber, Alan M
dash.embargo.until10000-01-01
dc.identifier.doi10.7326/0003-4819-154-1-201101040-00289*
dash.contributor.affiliatedGarber, Alan


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