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
1
PharmacoEconomics & Outcomes News 8 Jan 2011 No. 6191173-5503/10/0619-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
