Dabigatran cost effective in AF but stroke and bleeding risk important
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Dabigatran cost effective in AF but stroke and bleeding risk important Dabigatran etexilate appears to be more cost effective for the prevention of stroke in patients with atrial fibrillation (AF) than other anticoagulants, overall, but cost effectiveness varies with stroke risk and bleeding risk according to findings of a US study published in PharmacoEconomics. A Markov model populated with data from the IBM MarketScan database was used to evaluate the cost effectiveness of dabigatran, rivaroxaban, apixaban and edoxaban, compared with warfarin, in a hypothetical cohort of 10 000 patients with AF, overall and in subgroups based on stroke risk score (CHA2DS2-VASc score) and bleeding risk score (HAS-BLED score). Cost effectiveness was assessed from a US private payer perspective over a lifetime horizon. In the base case analysis, the estimated QALY gain was greatest with dabigatran (7.45) and lowest with warfarin (7.11), while costs were greatest with rivaroxaban ($57 621*) and lowest with warfarin ($42 044). All directacting oral anticoagulants were cost effective compared with warfarin. Dabigatran was the most cost-effective anticoagulant, with estimated incremental cost-effectiveness ratios (ICERs) of $35 055 per QALY gained versus warfarin and $30 825 versus edoxaban. In subgroup analysis with stratification by stroke risk score and bleeding risk score, edoxaban was the preferred treatment in patients with a low risk of stroke and a low or medium risk of bleeding, or with a high risk of stroke and a low risk of bleeding, while apixaban was the preferred treatment in those with a medium risk of stroke and a low risk of bleeding. Sensitivity analysis found that results were sensitive to drug costs and hazard ratios for stroke and bleeding. In probability sensitivity analysis, dabigatran was more cost effective than other treatment options in 32.8% at a willingness-to-pay (WTP) threshold of $50 000 per QALY gained and in 42.4% of iterations at a WTP of $100 000 per QALY gained. "From a US private payer’s perspective, dabigatran appears cost effective overall compared with other anticoagulants but the optimal therapy varied by stroke and bleed risk stratification. This study indicated risk stratification that considers both stroke and bleed risk simultaneously is important not only in clinical practice but also in health technology assessment exercises among patients with AF," concluded the authors. * 2018 US dollars Wang CY, et al. Updating the Cost Effectiveness of Oral Anticoagulants for Patients with Atrial Fibrillation Based on Varying Stroke and Bleed Risk Profiles. PharmacoEconomics : 14 Sep 2020. Available from: URL: http://doi.org/10.1007/s40273-020-00960-0
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Reactions 26 Sep 2020 No. 1823
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