title: Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in patients with atrial fibrillation--a real patient data analysis in a Hong Kong teaching hospital.
abstract: BACKGROUND
  To compare the management cost and cost-effectiveness of dabigatran with warfarin in patients with nonvalvular atrial fibrillation (AF) from the hospital's and patients' perspectives.
  
  
  OBJECTIVE
  Dabigatran is more cost-effective than warfarin for stroke prevention of AF in Hong Kong.
  
  
  METHODS
  The analysis was performed in conjunction with a drug utilization evaluation of dabigatran study in a teaching hospital in Hong Kong. The study recruited 244 patients who received either dabigatran or warfarin for stroke prevention of AF. A cost-effectiveness analysis was performed and was expressed as an incremental cost-effectiveness ratio (ICER) in averting a cardiac event or a bleeding event. A sensitivity analysis was used on all relevant variables to test the robustness.
  
  
  RESULTS
  From the hospital's perspective, the dabigatran group had a lower total cost of management than that of the warfarin group (median: US$421 vs US$1306, P < 0.001) (US$1 = HK$7.75) and was dominant over warfarin. From the patients' perspective, the total cost of management in the dabigatran group was higher than that in warfarin group (median: US$1751 vs US$70, P < 0.001), and the ICER in preventing a cardiac or bleeding event of dabigatran vs warfarin was estimated at US$68,333 and US$20,500, respectively. If dabigatran was subsidized by the hospital, a higher cost would be incurred by the hospital (median: US$1679 vs US$1306, ICER (cardiac and bleeding events): US$15,163 and US$4549, respectively).
  
  
  CONCLUSIONS
  The study favored dabigatran for stroke prophylaxis in patients with nonvalvular AF in Hong Kong under the current hospital's perspective and provided a reference for further comparisons under patient and subsidization perspectives.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Andy M
authors.initials: AM
authors.lastname: Chang
authors.forename: Jason C S
authors.initials: JC
authors.lastname: Ho
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: Cheuk Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Yat Yin
authors.initials: YY
authors.lastname: Lam
authors.forename: Vivian W Y
authors.initials: VW
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D001562:Benzimidazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D017723:Drug Utilization Review; D005260:Female; D005102:Health Expenditures; D006723:Hong Kong; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; 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; D014859:Warfarin; D000069604:Dabigatran