dabigatran: an alternative to warfarin despite higher cost?

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PharmacoEconomics & Outcomes News 619 - 8 Jan 2011 Dabigatran: an alternative to warfarin despite higher cost? Dabigatran etexilate could be a "cost-effective alternative to adjusted-dose warfarin" for the prevention of stroke in the USA, according to results from a study published in the Annals of Internal Medicine. Researchers used data from the RE-LY * trial to estimate the costs and QALYs associated with the use of low- and high-dose dabigatran compared with warfarin in patients aged more than 65 years with non-valvular atrial fibrillation and an increased risk for stroke ** . Using a Markov model the costs were calculated at 2008 values over a patient’s lifetime (35 years) from the perspective of an "ideal insurer". The drug cost for dabigatran is not yet available in the US, so was estimated to be $US9.50/day for low-dose (110mg twice daily) therapy and $13.00/day for high-dose (150mg twice daily) therapy. They calculated that the incremental cost- effectiveness ratio for dabigatran was $US51 229 (low- dose) and $45 372 (high-dose) compared with warfarin. The researchers suggest that at a willingness-to-pay threshold of $50 000/QALY, low-dose dabigatran may be the "preferred" option for patients with a low absolute risk of ischaemic stroke. The Editors of the Annals of Internal Medicine note caution when interpreting these results. They say that the analysis is dependent on results from a "manufacturer-sponsored study" and also note that dabigatran appears to be less cost effective if daily costs exceed $9.36 (low dose) and $13.70 (high dose). * Randomised Evaluation of Long-Term Anticoagulation Therapy ** CHADS score of 1 or equivalent Freeman JV, et al. Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention inAtrial Fibrillation. Annals of Internal Medicine : Nov 2010. Available from: URL: http:// dx.doi.org/10.1059/0003-4819-154-1-201101040-00289 803044546 1 PharmacoEconomics & Outcomes News 8 Jan 2011 No. 619 1173-5503/10/0619-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

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Page 1: Dabigatran: an alternative to warfarin despite higher cost?

PharmacoEconomics & Outcomes News 619 - 8 Jan 2011

Dabigatran: an alternative towarfarin despite higher cost?

Dabigatran etexilate could be a "cost-effectivealternative to adjusted-dose warfarin" for the preventionof stroke in the USA, according to results from a studypublished in the Annals of Internal Medicine.

Researchers used data from the RE-LY* trial toestimate the costs and QALYs associated with the use oflow- and high-dose dabigatran compared with warfarinin patients aged more than 65 years with non-valvularatrial fibrillation and an increased risk for stroke**. Usinga Markov model the costs were calculated at 2008values over a patient’s lifetime (35 years) from theperspective of an "ideal insurer". The drug cost fordabigatran is not yet available in the US, so wasestimated to be $US9.50/day for low-dose (110mg twicedaily) therapy and $13.00/day for high-dose (150mgtwice daily) therapy.

They calculated that the incremental cost-effectiveness ratio for dabigatran was $US51 229 (low-dose) and $45 372 (high-dose) compared with warfarin.The researchers suggest that at a willingness-to-paythreshold of $50 000/QALY, low-dose dabigatran maybe the "preferred" option for patients with a low absoluterisk of ischaemic stroke.

The Editors of the Annals of Internal Medicine notecaution when interpreting these results. They say thatthe analysis is dependent on results from a"manufacturer-sponsored study" and also note thatdabigatran appears to be less cost effective if daily costsexceed $9.36 (low dose) and $13.70 (high dose).* Randomised Evaluation of Long-Term Anticoagulation Therapy** CHADS score of ≥1 or equivalent

Freeman JV, et al. Cost-Effectiveness of Dabigatran Compared With Warfarin forStroke Prevention inAtrial Fibrillation. Annals of Internal Medicine : Nov 2010.Available from: URL: http://dx.doi.org/10.1059/0003-4819-154-1-201101040-00289 803044546

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PharmacoEconomics & Outcomes News 8 Jan 2011 No. 6191173-5503/10/0619-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved