Dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation in Canada. Comparative efficacy and cost-effectiveness.
Canadian patients with atrial fibrillation (AF) in whom anticoagulation is appropriate have two new choices for anticoagulation for prevention of stroke and systemic embolism--dabigatran etexilate (dabigatran) and rivaroxaban. Based on the RE-LY and ROCKET AF trial results, we investigated the cost-effectiveness of dabigatran (twice daily dosing of 150 mg or 110 mg based on patient age) versus rivaroxaban from a Canadian payer perspective. A formal indirect treatment comparison (ITC) of dabigatran versus rivaroxaban was performed, using dabigatran clinical event rates from RE-LY for the safety-on-treatment population, adjusted to the ROCKET AF population. A previously described Markov model was modified to simulate anticoagulation treatment using ITC results as inputs. Model outputs included total costs, event rates, and quality-adjusted life-years (QALYs). The ITC found when compared to rivaroxaban, dabigatran had a lower risk of intracranial haemorrhage (ICH) (relative risk [RR] = 0.38; 95% confidence interval [CI] 0.21 - 0.67) and stroke (RR = 0.62; 95%CI 0.45-0.87). Over a lifetime horizon, the model found dabigatran-treated patients experienced fewer ICHs (0.33 dabigatran vs. 0.71 rivaroxaban) and ischaemic strokes (3.40 vs. 3.96) per 100 patient-years, and accrued more QALYs (6.17 vs. 6.01). Dabigatran-treated patients had lower acute care and long-term follow-up costs per patient ($52,314 vs. $53,638) which more than offset differences in drug costs ($7,299 vs. $6,128). In probabilistic analysis, dabigatran had high probability of being the most cost-effective therapy at common thresholds of willingness-to-pay (93% at a $20,000/QALY threshold). This study found dabigatran is economically dominant versus rivaroxaban for prevention of stroke and systemic embolism among Canadian AF patients.
United BioSource Corporation, Bethesda, MD 20814, USA. anuraag.kansal@unitedbiosource.com
Anuraag R
AR
Kansal
Michael
M
Sharma
Carole
C
Bradley-Kennedy
Andreas
A
Clemens
Brigitta U
BU
Monz
Siyang
S
Peng
Neil
N
Roskell
Sonja V
SV
Sorensen
D000925:Anticoagulants / Q000191:economics / Q000494:pharmacology; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000191:economics / Q000494:pharmacology*; D002170:Canada; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D004617:Embolism / Q000517:prevention & control*; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009025:Morpholines / Q000191:economics / Q000494:pharmacology*; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban; D020521:Stroke / Q000517:prevention & control*; D013876:Thiophenes / Q000191:economics / Q000494:pharmacology*; D016896:Treatment Outcome; D014859:Warfarin / Q000494:pharmacology; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology
D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran