title: Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation.
abstract: OBJECTIVE
  To assess the cost-effectiveness of dabigatran etexilate, a new oral anticoagulant, versus warfarin and other alternatives for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation (AF).
  
  
  METHODS
  A Markov model estimated the cost-effectiveness of dabigatran etexilate versus warfarin, aspirin or no therapy. Two patient cohorts with AF (starting age of <80 and ≥80 years) were considered separately, in line with the UK labelled indication. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Patients treated with dabigatran etexilate experienced fewer ischaemic strokes (3.74 dabigatran etexilate vs 3.97 warfarin) and fewer combined intracranial haemorrhages and haemorrhagic strokes (0.43 dabigatran etexilate vs 0.99 warfarin) per 100 patient-years. Larger differences were observed comparing dabigatran etexilate with aspirin or no therapy. For patients initiating treatment at ages <80 and ≥80 years, the ICERs for dabigatran etexilate were £4831 and £7090/QALY gained versus warfarin with a probability of cost-effectiveness at £20 000/QALY gained of 98% and 63%, respectively. For the patient cohort starting treatment at ages <80 years, the ICER versus aspirin was £3457/QALY gained and dabigatran etexilate was dominant (ie, was less costly and more effective) compared with no therapy. These results were robust in sensitivity analyses.
  
  
  CONCLUSIONS
  This economic evaluation suggests that the use of dabigatran etexilate as a first-line treatment for the prevention of stroke and systemic embolism is likely to be cost-effective in eligible UK patients with AF.
authors.affiliation: United BioSource Corporation, Bethesda, Maryland, USA.
authors.forename: Anuraag R
authors.initials: AR
authors.lastname: Kansal
authors.forename: Sonja V
authors.initials: SV
authors.lastname: Sorensen
authors.forename: Ray
authors.initials: R
authors.lastname: Gani
authors.forename: Paul
authors.initials: P
authors.lastname: Robinson
authors.forename: Feng
authors.initials: F
authors.lastname: Pan
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Plumb
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
mesh_terms: D000369:Aged, 80 and over; D058833:Antithrombin Proteins; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D016527:Drug Costs; D004617:Embolism / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018803:Models, Economic; D011725:Pyridines / Q000191:economics* / Q000627:therapeutic use; D020521:Stroke / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D006113:United Kingdom
chemical_list: D058833:Antithrombin Proteins; D001562:Benzimidazoles; D011725:Pyridines; D000069604:Dabigatran