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Thromb Haemost 2011; 105(05): 908-919
DOI: 10.1160/TH11-02-0089
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

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

Sonja V. Sorensen
1   United BioSource Corporation, Bethesda, Maryland, USA
,
Anuraag R. Kansal
1   United BioSource Corporation, Bethesda, Maryland, USA
,
Stuart Connolly
2   Population Health Research Institute, Hamilton, Ontario, Canada
,
Siyang Peng
1   United BioSource Corporation, Bethesda, Maryland, USA
,
John Linnehan
1   United BioSource Corporation, Bethesda, Maryland, USA
,
Carole Bradley-Kennedy
3   Boehringer Ingelheim (Canada) Ltd., Burlington, Ontario, Canada
,
Jonathan M. Plumb
4   Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
› Author Affiliations Financial support:The project was funded by Boehringer Ingelheim Canada Ltd (BI).
Further Information

Publication History

Received: 09 February 2011

Accepted after minor revision: 14 March 2011

Publication Date:
28 November 2017 (online)

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Summary

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.

Keywords

Anticoagulation - dabigatran etexilate - warfarin - stroke - cost-effectiveness - atrial fibrillation

 

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