title: Cost-Effectiveness of Dabigatran Exilate in Treatment of Atrial Fibrillation.
abstract: BACKGROUND
  Dabigatran exilate has emerged as a highly effective tool in treating atrial fibrillation, AF). Its relative convenience in terms of cost and overall utility with respect to other anti-coagulants, however, has not been explored in much detail yet.
  
  
  RESULTS
  We run a Markovian disease simulation model based on a cohort of 1000 randomly generated patients which were sub-grouped by average risk of hemorrhage and average risk of stroke to compare treatments with Aspirin, Warfarin and Dabigatran. Quality-adjusted life-year, QALYs) for the patients were projected over up to 30 years with mortality statistics database and properly adjusted after every 5-year survival from the starting date. If managed within the prescribed range, Warfarin offers the highest outcome in terms of QALYs: 7.93 versus 7.61 for the Aspirin treatment and 7.57 for highest dose treatment with Dabigatran. Dabigatran outperformed the other treatments in patients at high risk of major stroke, provided Warfarin was not managed optimally. The incremental cost-effectiveness ratio for Dabigatran versus sub-optimally managed Warfarin was €7,759.48/QALY meaning that every year in perfect health earned with Dabigatran cost less than €8,000 more than the alternative treatment with Warfarin.
  
  
  CONCLUSIONS
  The therapy with high-dose Dabigatran proved the most clinically safe solution for patients at high risk of stroke unless Warfarin therapy was excellent.
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Galvani
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Alberto
authors.initials: A
authors.lastname: Grassetto
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Stefania
authors.initials: S
authors.lastname: Sterlicchio
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Venturini
authors.initials: V
authors.lastname: Andrea
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Zoffoli
authors.initials: Z
authors.lastname: Giampaolo
authors.affiliation: Dirigente Medico, Unità Operativa di Cardiochirurgia, Responsabile della Qualità di reparto, Azienda ULSS 12 Veneziana, Ospedale dell'Angelo, Venezia-Mestre.
authors.forename: Mangino
authors.initials: M
authors.lastname: Domenico