Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation

Freeman, James V.; Zhu, Ruo P.; Owens, Douglas K; Garber, Alan M.; Hutton, David; Go, Alan S.; Wang, Paul J.; Turakhia, Mintu P.

doi:10.7326/0003-4819-154-1-201101040-00289

Cited by 375 publications

(326 citation statements)

References 59 publications

Supporting

Mentioning

303

Contrasting

Unclassified

Order By: Relevance

“…The current finding is consistent with previously reported cost-effectiveness analyses of dabigatran versus warfarin, in which the ICER of dabigatran would increase as its utility score decreased. 13,47 The three-way sensitivity analysis explored the interaction of two cost-driving factors (monthly cost of NOACs and increment in monthly cost of anticoagulation service), as well as different levels of INR control on the cost-effectiveness of warfarin and NOACs. The results showed that at no increment in monthly service cost, warfarin therapy would be the costeffective option at TTR 60 %, 70 % and 75 % if the monthly drug cost of NOACs was >USD 200, >USD 122 and >USD 85, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] The costeffectiveness analyses based upon the treatment outcomes of these trials reported that NOACs were more costeffective than warfarin when anticoagulation control was suboptimal. [11][12][13][14][15][16][17] For anticoagulation centers with average TTR of 60 % or below, the possible options are either the use of more expensive NOACs, or providing additional resources to improve TTR. Various therapeutic strategies to improve TTR have been examined and the findings suggest that employment of a clinical factor-guided dosing algorithm, 18 frequent INR monitoring, [19][20][21] and management of anticoagulation care by specialists in the use of anticoagulants 22,23 are effective interventions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Novel Oral Anticoagulants Versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation—A Cost-Effectiveness Analysis

You

2013

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND:The decision as to whether to use more expensive novel oral anticoagulants (NOACs) or invest resources for quality improvement of warfarin therapy requires input from both clinical and economic analyses. OBJECTIVE: Cost-effectiveness of NOACs compared to warfarin therapy at various levels of patient-time in therapeutic range (TTR) in patients with atrial fibrillation was examined, from the healthcare provider's perspective. DESIGN, SUBJECTS AND INTERVENTION:A Markov model was used to compare life-long economic and treatment outcomes of warfarin and NOACs in a hypothetical cohort of 65-year-old atrial fibrillation patients with CHADS 2 scores of 2 or above. Model inputs were derived from clinical trials published in the literature. MAIN MEASURES: The outcome measure was incremental cost per quality-adjusted life-year (QALY) gained (ICER). KEY RESULTS: Using United States Dollar (USD) 50,000 as the threshold of willingness-to-pay per QALY, NOACs therapy was cost-effective when TTR of warfarin therapy was 60 % or below, or monthly cost of warfarin management increased by two-fold or more to achieve 70 % TTR. Warfarin therapy was cost-effective when TTR of warfarin was 70 % with up to a 1.5-fold increment in monthly cost of care, or when TTR reached 75 % with monthly cost of warfarin care increased up to three-fold. At TTR 60 %, 70 % and 75 %, NOACs was cost-effective when monthly drug cost was < USD 200, < USD 122-185 and < USD 85-145, respectively. 10,000 Monte Carlo simulations showed NOACs to be cost-effective 83.6 %, 50.7 % and 32.7 % of the time at TTR of 60 %, 70 % and 75 %, respectively. CONCLUSIONS: The acceptance of NOACs as costeffective was highly dependent upon drug cost, anticoagulation control for warfarin, and anticoagulation service cost.KEY WORDS: novel oral anticoagulants; warfarin; atrial fibrillation; cost-effectiveness.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Oral Anticoagulants Versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation—A Cost-Effectiveness Analysis

You

2013

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…Another big issue is the high cost of these drugs that, on the basis of the prices for licensed indications, is unlikely to be lower than €2-3 per day. Although in an economic analysis using data from the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial [60], dabigatran was estimated to be cost-effective compared to warfarin in patients with atrial fibrillation at high risk of stroke, their cost-effectiveness in a relatively short period of time (such as that encompassing most VTE treatments) is yet to be proven.…”

Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulants and venous thromboembolism

Franchini

Mannucci

2016

Eur Respir Rev

View full text Add to dashboard Cite

Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban) and thrombin inhibitors (e.g. dabigatran etexilate). This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE. @ERSpublications Direct oral anticoagulants represent an addition for the management of VTE

show abstract

“…13 be shown. 21 However, for a condition that requires long-term prophylaxis there are no long-term data to suggest that they will be safe and effective alternatives. The Watchman device is delivered by catheter to the left atrial appendage.…”

Section: Alternative Oral Anticoagulantsmentioning

confidence: 99%

Current management of atrial fibrillation

Samardhi¹,

Santos²,

Denman³

et al. 2011

Aust Prescr

View full text Add to dashboard Cite

SummaryAtrial fibrillation is a common condition and carries the risk of cerebral thromboembolism. The CHAdS 2 score is often used to stratify this risk. Anticoagulant therapy with warfarin significantly reduces this risk, but there are limitations to its use. This has prompted the use of antiplatelet drugs. Patients with mitral valve disease should always be considered for anticoagulant therapy. However for other patients with atrial fibrillation, the decision about which drug to use is based on the patient's risk of thromboembolism. in addition to stroke prevention, management is directed towards restoring and maintaining sinus rhythm or controlling the ventricular rate in those for whom permanent atrial fibrillation is accepted. For some patients percutaneous (catheterdirected) creation of lesions within the left atrium may be effective in maintaining sinus rhythm.

show abstract

Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation

Abstract: American Heart Association and Veterans Affairs Health Services Research & Development Service.

Cited by 375 publications

References 59 publications

Novel Oral Anticoagulants Versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation—A Cost-Effectiveness Analysis

Novel Oral Anticoagulants Versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation—A Cost-Effectiveness Analysis

Direct oral anticoagulants and venous thromboembolism

Current management of atrial fibrillation

Contact Info

Product

Resources

About