title: Indirect comparison and cost-utility of dabigatran etexilate and rivaroxaban in the treatment and extended anticoagulation of venous thromboembolism in a UK setting.
abstract: BACKGROUND
  Acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is traditionally managed with a short course of parenteral anticoagulation followed by 3-6 months of a vitamin-K antagonist. Non-vitamin K oral anticoagulants (NOACs) do not require routine monitoring and dose adjustment, thus potentially provide an alternative treatment option.
  
  
  RESULTS
  Because of the lack of head-to-head clinical studies, an indirect comparison was conducted of dabigatran etexilate and rivaroxaban based on the respective phase III clinical trial. The derived relative safety and efficacy estimates were used to evaluate the cost-utility of dabigatran compared with rivaroxaban in the treatment and secondary prevention of VTE. The results of the indirect comparison showed no significant difference between dabigatran and rivaroxaban in avoiding recurrent VTE following index PE, index DVT, or DVT/PE combined, in treatment and extended anticoagulation. Dabigatran has significantly less major or clinically relevant bleeds (MCRBE) compared to rivaroxaban in treatment after index DVT and treatment after DVT or PE combined, but was not significantly different from rivaroxaban after index PE or in extended anticoagulation. In cost-utility deterministic analyses, dabigatran was projected dominant in all analyzed settings, given its marginally lower total cost and marginally higher QALYs gained compared to rivaroxaban. Probabilistic analyses results showed a high likelihood of dabigatran being considered good value for money in the UK, in treatment and in secondary prevention of VTE.
  
  
  CONCLUSIONS
  The cost-effectiveness evaluations showed that dabigatran can be considered the dominant treatment strategy compared to rivaroxaban in the patients' sub-groups considered, given the projected marginally higher clinical benefits and lower treatment costs.
authors.affiliation: a a IMS HEOR , Vilvoorde , Belgium.
authors.forename: Anamaria Vera
authors.initials: AV
authors.lastname: Jugrin
authors.affiliation: b b StatSciConsult , Munich , Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Hösel
authors.affiliation: c c Boehringer Ingelheim GmbH , Ingelheim am Rhein , Germany.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ustyugova
authors.affiliation: a a IMS HEOR , Vilvoorde , Belgium.
authors.forename: Maria
authors.initials: M
authors.lastname: De Francesco
authors.affiliation: a a IMS HEOR , Vilvoorde , Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
authors.affiliation: d d Boehringer Ingelheim Ltd , Bracknell , UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Sunderland
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000069604:Dabigatran / Q000191:economics* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011655:Pulmonary Embolism / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years; D000069552:Rivaroxaban / Q000191:economics* / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Cost-effectiveness; Dabigatran; Indirect comparison; Rivaroxaban; Venous thrombosis