title: Cost-effectiveness of dabigatran for stroke prevention in non-valvular atrial fibrillation in Spain.
abstract: OBJECTIVE
  Assessment of the cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Spain, from the perspective of the National Health System.
  
  
  METHODS
  Adaptation of a Markov chain model that simulates the natural history of the disease over the lifetime of a cohort of 10,000 patients with non-valvular atrial fibrillation. Model comparators were warfarin in a first scenario, and a real world prescribing pattern in a second scenario, in which 60% of the patients were treated with vitamin K antagonists, 30% with acetylsalicylic acid, and 10% received no treatment. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Dabigatran reduced the occurrence of clinical events in both scenarios, providing gains in quantity and quality of life. The incremental cost-effectiveness ratio for dabigatran compared to warfarin was 17,581 euros/quality-adjusted life year gained and 14,118 euros/quality-adjusted life year gained when compared to the real world prescribing pattern. Efficiency in subgroups was demonstrated. When the social costs were incorporated into the analysis, dabigatran was found to be a dominant strategy (ie, more effective and less costly). The model proved to be robust.
  
  
  CONCLUSIONS
  From the perspective of the Spanish National Health System, dabigatran is an efficient strategy for the prevention of stroke in patients with non-valvular atrial fibrillation compared to warfarin and to the real-world prescribing pattern; incremental cost-effectiveness ratios were below the 30,000 euros/quality-adjusted life year threshold in both scenarios. Dabigatran would also be a dominant strategy from the societal perspective, providing society with a more effective therapy at a lower cost compared to the other 2 alternatives. Full English text available from:www.revespcardiol.org.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España.
authors.forename: José R
authors.initials: JR
authors.lastname: González-Juanatey
authors.forename: José
authors.initials: J
authors.lastname: Álvarez-Sabin
authors.forename: José M
authors.initials: JM
authors.lastname: Lobos
authors.forename: Antoni
authors.initials: A
authors.lastname: Martínez-Rubio
authors.forename: Joan C
authors.initials: JC
authors.lastname: Reverter
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.forename: Nuria
authors.initials: N
authors.lastname: González-Rojas
authors.forename: Virginia
authors.initials: V
authors.lastname: Becerra
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D001562:Benzimidazoles / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D004617:Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014812:Vitamin K; D014859:Warfarin; D000069604:Dabigatran