Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2012;65:901-10 - Vol. 65 Num.10 DOI: 10.1016/j.rec.2012.06.003

Cost-effectiveness of Dabigatran for Stroke Prevention in Non-valvular Atrial Fibrillation in Spain

José R. González-Juanatey a, José Álvarez-Sabin b, José M. Lobos c, Antoni Martínez-Rubio d, Joan C. Reverter e, Itziar Oyagüez f, Nuria González-Rojas g, Virginia Becerra g,

a Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
b Unidad Neurovascular, Servicio de Neurología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
c Centro de Salud Jazmín, Área Este, Atención Primaria, Madrid, Spain
d Servicio de Cardiología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
e Servicio de Hemoterapia y Hemostasia, Hospital Clínic, Barcelona, Spain
f Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain
g Departamento de Economía y Resultados en Salud, Boehringer Ingelheim, Barcelona, Spain

Refers to

On the Cost-effectiveness of Dabigatran
Santiago Soler-Martínez
Rev Esp Cardiol. 2013;66:512
Full text - PDF

Keywords

Cost-effectiveness. Stroke prevention. Atrial fibrillation.

Abstract

Introduction and objectives

Assessment of the cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Spain, from the perspective of the National Health System.

Methods

Adaptation of a Markov chain model that simulates the natural history of the disease over the lifetime of a cohort of 10 000 patients with non-valvular atrial fibrillation. Model comparators were warfarin in a first scenario, and a real world prescribing pattern in a second scenario, in which 60% of the patients were treated with vitamin K antagonists, 30% with acetylsalicylic acid, and 10% received no treatment. Deterministic and probabilistic sensitivity analyses were performed.

Results

Dabigatran reduced the occurrence of clinical events in both scenarios, providing gains in quantity and quality of life. The incremental cost-effectiveness ratio for dabigatran compared to warfarin was 17581 euros/quality-adjusted life year gained and 14118 euros/quality-adjusted life year gained when compared to the real world prescribing pattern. Efficiency in subgroups was demonstrated. When the social costs were incorporated into the analysis, dabigatran was found to be a dominant strategy (ie, more effective and less costly). The model proved to be robust.

Conclusions

From the perspective of the Spanish National Health System, dabigatran is an efficient strategy for the prevention of stroke in patients with non-valvular atrial fibrillation compared to warfarin and to the real-world prescribing pattern; incremental cost-effectiveness ratios were below the 30 000 euros/quality-adjusted life year threshold in both scenarios. Dabigatran would also be a dominant strategy from the societal perspective, providing society with a more effective therapy at a lower cost compared to the other 2 alternatives.

1885-5857/© 2012 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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