Dataset Information

Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.

ABSTRACT:

Objective

Dabigatran was the first of a new generation of anticoagulation drugs for the indication of non-valvular atrial fibrillation (AF) to be approved. Evidence show that dabigatran 150 mg twice daily significantly reduces the 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 110 mg twice daily was associated with a comparable rate of stroke and systemic embolism (RR = 0.90; p = 0.30) and a significantly 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 10 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 sub-groups; 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 normalized ratio (INR) control was excellent, and with high risk of stroke or in a low-quality warfarin treatment. Dabigatran 110 mg twice daily was in general dominated by dabigatran 150 mg 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 sub-groups, such as patients with a low TTR-value in warfarin treatment and a CHADS2 score ≥2.

SUBMITTER: Hesselbjerg LJ

PROVIDER: S-EPMC4627374 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.

Hesselbjerg Louise Justesen LJ Pedersen Heidi Sjoelund HS Asmussen Mikael Bergholdt MB Petersen Karin Dam KD

Journal of medical economics 20130515 7

<h4>Objective</h4>Dabigatran was the first of a new generation of anticoagulation drugs for the indication of non-valvular atrial fibrillation (AF) to be approved. Evidence show that dabigatran 150 mg twice daily significantly reduces the 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 110 mg twice daily was associated with a comparable rate of stroke and systemic embolism (RR = 0.90; p = 0.30) a ...[more]

PMID: 23621506

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Dataset Information

Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.

Objective

Methods

Results

Limitations

Conclusions

Publications

Is dabigatran considered a cost-effective alternative to warfarin treatment: a review of current economic evaluations worldwide.

Similar Datasets

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