title: Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation in Taiwan.
abstract: BACKGROUND
  Economic evaluation of dabigatran, a new anti-antithrombotic agent, is done mostly in Western countries. It remains to be seen whether dabigatran will be cost effective in a practice environment where warfarin is significantly underused and the costs of both warfarin and international normalized ration INR monitoring are cheap.
  
  
  METHODS
  We performed a cost-effectiveness analysis with a Markov model to evaluate the value of dabigatran to prevent stroke and systemic embolism in patients with atrial fibrillation (AF) in Taiwan. Dabigatran was given through sequential dosing, where patients<80 years old received 150 mg of dabigatran twice a day and the dosage was reduced to 110 mgs for patients ≥ 80 years old. Dabigatran was compared with warfarin under two scenarios: the "real-world adjusted-dose warfarin" assuming all AF patients eligible for warfarin were given the medication and maintained at the INR observed in routine clinical practice in Taiwan, and the "real-world prescribing behaviour" similar to the treatment with antithrombotics in real-world practice in Taiwan, where eligible patients could receive warfarin, aspirin, or no treatment.
  
  
  RESULTS
  The percentage of AF patients who received warfarin, aspirin or no treatment in Taiwan was 16%, 62% and 22%, respectively. The event rates of ischemic stroke per 100 patient-years were 4.5, 8.0, and 6.0 for sequential dabigatran, real-world prescribing behaviour and real-world warfarin use, respectively. The incremental cost-effectiveness ratio was $280 US per quality-adjusted-year (QALY) in the real-world prescribing scenario and $10,551 US/QALY in real-word warfarin use.
  
  
  CONCLUSIONS
  Dabigatran was highly cost-effective in a clinical practice setting where warfarin has been significantly underused.
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chia-Hsien
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Health Outcome Research Centre, National Cheng Kung University, Tainan, Taiwan. Electronic address: yhkao@mail.ncku.edu.tw.
authors.forename: Yea-Huei Kao
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Jyh-Hong
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran; D004617:Embolism / Q000191:economics / Q000517:prevention & control*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D011725:Pyridines / Q000008:administration & dosage* / Q000191:economics*; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D013624:Taiwan; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D011725:Pyridines; D014859:Warfarin; D000069604:Dabigatran
keywords: Atrial fibrillation; Cost-effectiveness analysis; Dabigatran; Stroke prevention; Warfarin