Journal
THROMBOSIS RESEARCH
Volume 133, Issue 5, Pages 782-789Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.thromres.2014.02.024
Keywords
Warfarin; Dabigatran; Cost-effectiveness analysis; Atrial fibrillation; Stroke prevention
Categories
Funding
- Boehringer Ingelheim GmbH
- Boehringer Ingelheim
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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. (C) 2014 Elsevier Ltd. All rights reserved.
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