Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective

• Published in: Thrombosis and haemostasis Vol. 105; no. 5; p. 908
• Main Authors: Sorensen, S V, Kansal, A R, Connolly, S, Peng, S, Linnehan, J, Bradley-Kennedy, C, Plumb, J M
• Format: Journal Article
• Language: English
• Published: Germany 01.05.2011
• Subjects: Aged; Atrial Fibrillation - drug therapy; Atrial Fibrillation - economics; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Benzimidazoles - economics; Benzimidazoles - therapeutic use; Canada; Computer Simulation; Cost of Illness; Cost-Benefit Analysis; Dabigatran; Embolism, Air - prevention & control; Female; Humans; Intracranial Hemorrhages - prevention & control; Ischemic Attack, Transient - prevention & control; Male; Markov Chains; Pyridines - economics; Pyridines - therapeutic use; Quality-Adjusted Life Years; Stroke - prevention & control; Warfarin - economics; Warfarin - therapeutic use; Canada
• ISSN: 0340-6245
• DOI: 10.1160/th11-02-0089

Oral dabigatran etexilate is indicated for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) in whom anticoagulation is appropriate. Based on the RE-LY study we investigated the cost-effectiveness of Health Canada approved dabigatran etexilate dosing (150 mg bid for patients <80 years, 110 mg bid for patients ≥80 years) versus warfarin and "real-world" prescribing (i.e. warfarin, aspirin, or no treatment in a cohort of warfarin-eligible patients) from a Canadian payer perspective. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on a Canadian prospective study, published literature, and national statistics. Clinical events, summarized as events per 100 patient-years, quality-adjusted life years (QALYs), total costs, and incremental cost effectiveness ratios (ICER) were calculated. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages (0.49 dabigatran etexilate vs. 1.13 warfarin vs. 1.05 "real-world" prescribing) and fewer ischaemic strokes (4.40 dabigatran etexilate vs. 4.66 warfarin vs. 5.16 "real-world" prescribing) per 100 patient-years. The ICER of dabigatran etexilate was $10,440/QALY versus warfarin and $3,962/QALY versus "real-world" prescribing. This study demonstrates that dabigatran etexilate is a highly cost-effective alternative to current care for the prevention of stroke and systemic embolism among Canadian AF patients.