Dabigatran may be cost-effective for stroke prophylaxis in atrial fibrillation
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Dabigatran may be a cost-effective method of stroke prophylaxis in patients with atrial fibrillation (AF), according to a new study.
The FDA recently approved dabigatran, a fixed-dose, oral direct thrombin inhibitor, for stroke prophylaxis in AF. Researchers used a computer model to perform a decision analysis comparing the quality-adjusted survival, costs, and cost-effectiveness of three treatment strategies for stroke prevention in patients with AF: adjusted-dose warfarin (target international normalized ratio, 2.0 to 3.0), low-dose dabigatran (110 mg twice daily), or high-dose dabigatran (150 mg twice daily). The study results were published online Nov. 2 by Annals of Internal Medicine.
The target population was patients 65 years and older with nonvalvular AF, risk factors for stroke and no contraindications to anticoagulation. In the base-case analysis, the quality-adjusted life expectancy was 10.28 quality-adjusted life-years (QALYs) with warfarin, 10.70 QALYs with low-dose dabigatran and 10.84 QALYs with high-dose dabigatran. Total costs for the three regimens were $143,103, $164,576 and $168,398, respectively.
Compared with warfarin, the incremental cost-effectiveness ratios were $51,229 per QALY for low-dose dabigatran and $45,372 per QALY for high-dose dabigatran. In the sensitivity analysis, the incremental cost-effectiveness ratio was $50,000 per QALY when high-dose dabigatran was estimated to cost $13.70 per day but remained under $85,000 per QALY for all model inputs evaluated. High-dose dabigatran became more cost-effective when risk for stroke and intracranial hemorrhage increased.
The authors noted that the efficacy and adverse event rates used in their model came mainly from one randomized, controlled trial and that dabigatran costs were based on those in the United Kingdom. However, they concluded that high-dose dabigatran may be a cost-effective alternative to warfarin in patients age 65 years or older with an increased stroke risk, depending on U.S. drug prices.