title: Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.
abstract: OBJECTIVE
  Dabigatran was the first of a new generation of anticoagulation drugs for the indication of non-valvular atrial fibrillation (AF) to be approved. Evidence show that dabigatran 150 mg twice daily significantly reduces the risk of stroke and systemic embolism (RR = 0.65; p < 0.001) and shows a comparable rate of major bleedings (RR = 0.93; p = 0.32), whereas dabigatran 110 mg twice daily was associated with a comparable rate of stroke and systemic embolism (RR = 0.90; p = 0.30) and a significantly lower rate of major bleedings compared to warfarin treatment (RR = 0.80; p = 0.003). The purpose is to review current economic evaluations of these alternatives for healthcare professionals to include these findings in their decision-making.
  
  
  METHODS
  A systematic literature search identified 43 economic evaluations, of which 10 were included and evaluated according to the Consensus Health Economic Criteria list (CHEC-list) and the Oxford model.
  
  
  RESULTS
  Six economic evaluations concluded that dabigatran was a cost-effective alternative to warfarin. One evaluation concluded the same except when quality in warfarin treatment was excellent, with a mean time in therapeutic range (TTR) > 73%. Three evaluations concluded that dabigatran was a cost-effective alternative to warfarin in patient sub-groups; TTR ≤ 64%, congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, prior stroke or transient ischemic attack (CHADS2 score) ≥3, or a CHADS2 score = 2 unless international normalized ratio (INR) control was excellent, and with high risk of stroke or in a low-quality warfarin treatment. Dabigatran 110 mg twice daily was in general dominated by dabigatran 150 mg twice daily.
  
  
  CONCLUSIONS
  The evaluations were not fully homogeneous, as some did not include loss of productivity, costs of dyspepsia, and annual costs of dabigatran patient management.
  
  
  CONCLUSIONS
  In the majority of the economic evaluations, dabigatran is a cost-effective alternative to warfarin treatment. In some evaluations dabigatran is only cost-effective in sub-groups, such as patients with a low TTR-value in warfarin treatment and a CHADS2 score ≥2.
authors.affiliation: Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark. louisejhesselbjerg@gmail.com
authors.forename: Louise Justesen
authors.initials: LJ
authors.lastname: Hesselbjerg
authors.forename: Heidi Sjoelund
authors.initials: HS
authors.lastname: Pedersen
authors.forename: Mikael Bergholdt
authors.initials: MB
authors.lastname: Asmussen
authors.forename: Karin Dam
authors.initials: KD
authors.lastname: Petersen
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000191:economics*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D004617:Embolism / Q000517:prevention & control; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran