title: Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands.
abstract: BACKGROUND
  Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting.
  
  
  METHODS
  Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RE-SONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving €1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at €2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at €33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving.
  
  
  CONCLUSIONS
  From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands.
authors: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands.
authors: J
authors: J
authors: Stevanović
authors: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands.
authors: L A
authors: LA
authors: de Jong
authors: Boehringer Ingelheim, Alkmaar, the Netherlands.
authors: B S
authors: BS
authors: Kappelhoff
authors: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands.
authors: E P
authors: EP
authors: Dvortsin
authors: Boehringer Ingelheim, Alkmaar, the Netherlands.
authors: M
authors: M
authors: Voorhaar
authors: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands.|Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands.|Department of Epidemiology, UMCG, University of Groningen, Groningen, the Netherlands.
authors: M J
authors: MJ
authors: Postma
mesh_terms: D000991:Antithrombins / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000069604:Dabigatran / Q000627:therapeutic use*; D006801:Humans; D008962:Models, Theoretical; D009426:Netherlands; D011336:Probability; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*
chemical_list: D000991:Antithrombins; D000069604:Dabigatran