Cost-effectiveness of dabigatran etexilate for stroke prevention in non-valvular atrial fibrillation. Applying RE-LY to clinical practice in Denmark

Langkilde, Lars K.; Asmussen, Mikael; Overgaard, Mikkel

doi:10.3111/13696998.2012.673525

Cited by 46 publications

(31 citation statements)

References 22 publications

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“…In fact, in several studies, dabigatran etexilate was found to be cost effective among different countries and settings [61,[66][67][68][69]. Similarly, two analyses recently established the cost effectiveness of rivaroxaban [21,22] from a US payer/Medicare perspective.…”

Section: Discussionmentioning

confidence: 97%

Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation

et al. 2014

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Our results showed that the substantially higher medication costs of rivaroxaban were offset by mitigating the shortcomings of warfarin, most notably frequent dose regulation and bleeding risk. Future health economic studies on novel oral anticoagulants should evaluate the cost effectiveness for secondary stroke prevention and, as clinical data from direct head-to-head comparisons become available, new anticoagulation therapies should be compared against each other.

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Section: Discussionmentioning

confidence: 97%

Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation

et al. 2014

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“…Current guidelines for stroke prevention published jointly by the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society as well as those from the American College of Chest Physicians [44], [45] recommend the oral direct thrombin inhibitor, dabigatran, as an alternative to warfarin for patients who are at moderate to high risk for stroke. [3] Dabigatran has been found to be a cost – effective alternative in this population in a large majority of published economic models [12], [46]–[50]. At present, only a single published Markov model has evaluated the oral factor Xa inhibitor, rivaroxaban's, cost-effectiveness compared to warfarin in this setting [51].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation

et al. 2012

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BackgroundApixaban was shown to be superior to adjusted-dose warfarin in preventing stroke or systemic embolism in patients with atrial fibrillation (AF) and at least one additional risk factor for stroke, and associated with reduced rates of hemorrhage. We sought to determine the cost-effectiveness of using apixaban for stroke prevention.MethodsBased on the results from the Apixaban Versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE) trial and other published studies, we constructed a Markov model to evaluate the cost-effectiveness of apixaban versus warfarin from the Medicare perspective. The base-case analysis assumed a cohort of 65-year-old patients with a CHADS2 score of 2.1 and no contraindication to oral anticoagulation. We utilized a 2-week cycle length and a lifetime time horizon. Outcome measures included costs in 2012 US$, quality-adjusted life-years (QALYs), life years saved and incremental cost-effectiveness ratios.ResultsUnder base case conditions, quality adjusted life expectancy was 10.69 and 11.16 years for warfarin and apixaban, respectively. Total costs were $94,941 for warfarin and $86,007 for apixaban, demonstrating apixaban to be a dominant economic strategy. Upon one-way sensitivity analysis, these results were sensitive to variability in the drug cost of apixaban and various intracranial hemorrhage related variables. In Monte Carlo simulation, apixaban was a dominant strategy in 57% of 10,000 simulations and cost-effective in 98% at a willingness-to-pay threshold of $50,000 per QALY.ConclusionsIn patients with AF and at least one additional risk factor for stroke and a baseline risk of ICH risk of about 0.8%, treatment with apixaban may be a cost-effective alternative to warfarin.

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“…We excluded patients on a forced INR schedule from the study and, logically, determining the number of INR tests in a 6-month period is not applicable for patients who are managed using a fixed INR testing schedule. Although cost-effectiveness analyses have shown that NOACs are cost-effective from a societal perspective [18][19][20][21], national drug plans, Medicare and other drugreimbursing organizations cannot realistically absorb the difference in price between a tablet of VKA (from 0.25 to 0.50 CAN$ per day) and the NOACs (from 2.85 to 4.20 CAN$ per day). However, the identification of patients with poor anticoagulation control on VKAs may lead to more effective and well tolerated treatment with NOACs that may actually be associated with a cost savings, realized through a reduction in morbidity and hospitalizations and an increase in quality of life.…”

Section: Discussionmentioning

confidence: 99%

A simple method to identify patients on long-term warfarin who may derive the most benefit from new oral anticoagulants

Carrier

Kimpton

Wells

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

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In many countries, new oral anticoagulants are only covered for patients with suboptimal anticoagulation control on vitamin K antagonists (VKAs). The quality of VKA management is often reported using the time in therapeutic range (TTR). We sought to predict a TTR 65% or less using a surrogate measure [number of changes in VKA dose and number of international normalized ratio (INR) tests] that could be easily determined by primary care physicians. This cross-sectional study included consecutive patients whose VKA therapy was managed in a specialized anticoagulation clinic. Patients were dichotomized according to their TTR in the past 6 months (TTR > or ≤ 65%). The ability of the number of INR tests and VKA dose changes to predict TTR group was assessed using receiver-operating characteristics (ROC) curve analysis. The analyses included 1381 patients with a median age of 63 years. The mean TTR was 81% (interquartile range 70-90) and 17.4% of patients had a TTR 65% or more. Based on the ROC curve, patients were stratified according to whether they had either 3 or more dose changes or 9 or more INR tests within the last 6 months. The sensitivity to identify patients with TTR 65% or less was 87% and the specificity was 63%. The number of dose changes and the number of INR tests might be used as indicators of TTR; they could offer a simple way for clinicians to identify patients who are good candidates for the new oral anticoagulants. However, external validation studies in different clinical settings are needed to confirm these findings.

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Cost-effectiveness of dabigatran etexilate for stroke prevention in non-valvular atrial fibrillation. Applying RE-LY to clinical practice in Denmark

Abstract: Based on the outcomes observed in the RE-LY trial, dabigatran represents a cost-effective alternative to warfarin in Denmark for all patients with atrial fibrillation within the licensed indication of dabigatran.

Cited by 46 publications

References 22 publications

Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation

Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation

Cost-Effectiveness of Apixaban Compared with Warfarin for Stroke Prevention in Atrial Fibrillation

A simple method to identify patients on long-term warfarin who may derive the most benefit from new oral anticoagulants

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