title: Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective.
abstract: Oral dabigatran etexilate is indicated for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) in whom anticoagulation is appropriate. Based on the RE-LY study we investigated the cost-effectiveness of Health Canada approved dabigatran etexilate dosing (150 mg bid for patients <80 years, 110 mg bid for patients ≥80 years) versus warfarin and "real-world" prescribing (i.e. warfarin, aspirin, or no treatment in a cohort of warfarin-eligible patients) from a Canadian payer perspective. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on a Canadian prospective study, published literature, and national statistics. Clinical events, summarized as events per 100 patient-years, quality-adjusted life years (QALYs), total costs, and incremental cost effectiveness ratios (ICER) were calculated. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages (0.49 dabigatran etexilate vs. 1.13 warfarin vs. 1.05 "real-world" prescribing) and fewer ischaemic strokes (4.40 dabigatran etexilate vs. 4.66 warfarin vs. 5.16 "real-world" prescribing) per 100 patient-years. The ICER of dabigatran etexilate was $10,440/QALY versus warfarin and $3,962/QALY versus "real-world" prescribing. This study demonstrates that dabigatran etexilate is a highly cost-effective alternative to current care for the prevention of stroke and systemic embolism among Canadian AF patients.
authors: United BioSource Corporation, Bethesda, Maryland, USA. sonja.sorensen@unitedbiosource.com
authors: S V
authors: SV
authors: Sorensen
authors: A R
authors: AR
authors: Kansal
authors: S
authors: S
authors: Connolly
authors: S
authors: S
authors: Peng
authors: J
authors: J
authors: Linnehan
authors: C
authors: C
authors: Bradley-Kennedy
authors: J M
authors: JM
authors: Plumb
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000503:physiopathology; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D003198:Computer Simulation; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D004618:Embolism, Air / Q000517:prevention & control; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D008390:Markov Chains; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000517:prevention & control; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use
chemical_list: D001562:Benzimidazoles; D011725:Pyridines; D014859:Warfarin; D000069604:Dabigatran