title: [Economic evaluation of dabigatran for stroke prevention in patients with non-valvular atrial fibrillation].
abstract: OBJECTIVE
  To estimate the cost-effectiveness and cost-utility of dabigatran in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Portugal.
  
  
  METHODS
  A Markov model was used to simulate patients' clinical course, estimating the occurrence of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and intra- and extracranial hemorrhage. The clinical parameters are based on the results of the RE-LY trial, which compared dabigatran with warfarin, and on a meta-analysis that estimated the risk of each event in patients treated with aspirin or with no antithrombotic therapy.
  
  
  RESULTS
  Dabigatran provides an increase of 0.331 life years and 0.354 quality-adjusted life years for each patient. From a societal perspective, these clinical gains entail an additional expenditure of 2978 euros. Thus, the incremental cost is 9006 euros per life year gained and 8409 euros per quality-adjusted life year.
  
  
  CONCLUSIONS
  The results show that dabigatran reduces the number of events, especially the most severe such as ischemic and hemorrhagic stroke, as well as their long-term sequelae. The expense of dabigatran is partially offset by lower event-related costs and by the fact that INR monitoring is unnecessary. It can thus be concluded that the use of dabigatran in clinical practice in Portugal is cost-effective.
authors.affiliation: Centro de Investigação Sobre Economia Portuguesa, Instituto Superior de Economia e Gestão, Lisbon, Portugal. luissm@cisep.iseg.utl.pt
authors.forename: Luís
authors.initials: L
authors.lastname: Silva Miguel
authors.forename: Evangelista
authors.initials: E
authors.lastname: Rocha
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D006801:Humans; D011174:Portugal; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran
keywords: AASÁ; AIT; AV; AVAQ; AVC; AVCH; AVCI; Acidente Isquémico Transitório; Acidente Vascular Cerebral; Acidente Vascular Cerebral Hemorrágico; Acidente Vascular Cerebral Isquémico; Acidente vascular cerebral; Anos de Vida; Anos de Vida Ajustados pela Qualidade; Atrial fibrillation; Cost-effectiveness; Custo-efetividade; Dabigatran; Dabigatrano; Duas vezes por dia; EAM; ES; Embolia Sistémica; Enfarte Agudo do Miocárdio; FA; Fibrilhação Auricular; Fibrilhação auricular; HI; Hemorragia Intracraniana; INR; IVA; Imposto sobre o Valor Acrescentado; International Normalized Ratio; Portugal; Prevention; Prevenção; RCEI; Rácio Custo Efetividade Incremental; Stroke; Uma vez por dia; bid; cido Acetilsalicilico; qd