Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation
- Anuraag R Kansal1,
- Sonja V Sorensen1,
- Ray Gani2,
- Paul Robinson2,
- Feng Pan1,
- Jonathan M Plumb3,
- Martin R Cowie4
- 1United BioSource Corporation, Bethesda, Maryland, USA
- 2Boehringer Ingelheim Ltd, Bracknell, UK
- 3Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany
- 4National Heart and Lung Institute, Imperial College London, London, UK
- Correspondence to Professor Martin R Cowie, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
Contributors All authors are in agreement with the content of the manuscript, are aware of this submission and guarantee for the work. JP, SVS and ARK designed and developed the model concept. ARK and FP implemented the model. All authors interpreted the model results and contributed to the development of the manuscript. Additionally, MRC advised on model adaptations with regards to its application in the UK setting. RG and PR collected data input for the model.
- Accepted 15 December 2011
Objective To assess the cost-effectiveness of dabigatran etexilate, a new oral anticoagulant, versus warfarin and other alternatives for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation (AF).
Methods A Markov model estimated the cost-effectiveness of dabigatran etexilate versus warfarin, aspirin or no therapy. Two patient cohorts with AF (starting age of <80 and ≥80 years) were considered separately, in line with the UK labelled indication. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs).
Results Patients treated with dabigatran etexilate experienced fewer ischaemic strokes (3.74 dabigatran etexilate vs 3.97 warfarin) and fewer combined intracranial haemorrhages and haemorrhagic strokes (0.43 dabigatran etexilate vs 0.99 warfarin) per 100 patient-years. Larger differences were observed comparing dabigatran etexilate with aspirin or no therapy. For patients initiating treatment at ages <80 and ≥80 years, the ICERs for dabigatran etexilate were £4831 and £7090/QALY gained versus warfarin with a probability of cost-effectiveness at £20 000/QALY gained of 98% and 63%, respectively. For the patient cohort starting treatment at ages <80 years, the ICER versus aspirin was £3457/QALY gained and dabigatran etexilate was dominant (ie, was less costly and more effective) compared with no therapy. These results were robust in sensitivity analyses.
Conclusions This economic evaluation suggests that the use of dabigatran etexilate as a first-line treatment for the prevention of stroke and systemic embolism is likely to be cost-effective in eligible UK patients with AF.
Funding Boehringer Ingelheim provided the funding for the health economists to perform the analyses required.
Competing interests This project was funded by Boehringer Ingelheim International GmbH (BI). AK, SS and FP were paid consultants to BI for this project. MC reports receiving a consultancy fee from BI. RG and PR are employees of BI UK Ltd at the time of the study. JP was an employee of BI GmbH.
Ethics approval Health economic modeling based on data from the RE-LY trial (which was ethics committee approved) and data from published UK resources.
Provenance and peer review Not commissioned; externally peer reviewed.
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