Is dabigatran considered a cost-effective alternative to warfarin treatment: A review of current economic evaluations worldwide.
J Med Econ. 2013 Apr 29;
Authors: Hesselbjerg LJ, Pedersen HS, Asmussen MB, Petersen KD
Abstract
Abstract Objective Dabigatran was the first of a new generation of anticoagulation drugs for the indication non-valvular atrial fibrillation (AF) to be approved. Evidence show that dabigatran 150mg twice daily significantly reduces risk of stroke and systemic embolism (RR 0.65; p<0.001) and shows a comparable rate of major bleedings (RR 0.93; p=0.32), whereas dabigatran 110mg twice daily was associated with a comparable rate of stroke and systemic embolism (RR 0.90; p=0.30) and a significant lower rate of major bleedings compared to warfarin treatment (RR 0.80; p=0.003). The purpose is to review current economic evaluations of these alternatives for healthcare professionals to include these findings in their decision-making. Methods A systematic literature search identified 43 economic evaluations of which ten were included and evaluated according to the Consensus Health Economic Criteria list (CHEC-list) and the Oxford model. Results Six economic evaluations concluded that dabigatran was a cost-effective alternative to warfarin. One evaluation concluded the same except when quality in warfarin treatment was excellent, with a mean time in therapeutic range (TTR)>73%. Three evaluations concluded that dabigatran was a cost-effective alternative to warfarin in patient subgroups; TTR≤64%, congestive heart failure, hypertension, age≥75, diabetes mellitus, prior stroke or transient ischemic attack (CHADS2 score)≥3 or a CHADS2 score=2 unless international normalised ratio (INR) control was excellent, and with high risk of stroke or in a low-quality warfarin treatment. Dabigatran 110mg twice daily was in general dominated by dabigatran 150mg twice daily. Limitations The evaluations were not fully homogeneous, as some did not include loss of productivity, costs of dyspepsia, and annual costs of dabigatran patient management. Conclusions In the majority of the economic evaluations, dabigatran is a cost-effective alternative to warfarin treatment. In some evaluations dabigatran is only cost-effective in subgroups, such as patients with a low TTR-value in warfarin treatment and a CHADS2 score≥2.
PMID: 23621506 [PubMed - as supplied by publisher]