Economic appraisal of dabigatran as first-line therapy for stroke prevention in atrial fibrillation
Objectives. To estimate the cost-effectiveness (CE) and budget impact of dabigatran compared with warfarin for the prevention of stroke in AF patients.
Methods. A previously published Markov model was populated with SA cost and mortality data to estimate the CE and budget impact analysis of dabigatran over a lifetime horizon. The model population consisted of a cohort of patients of whom those aged younger than 80 years used dabigatran 150 mg twice daily and those older than 80 years 110 mg twice daily. Modelled outcomes included total cost, quality-adjusted life years (QALYs) and incremental CE ratio (ICER), with the effectiveness measured by QALYs gained.
Results. Dabigatran compared with warfarin as first-line treatment was estimated to have an ICER of R93 290 and an average incremental cost per beneficiary per month of R0.39 over a 5-year period. Conservative assumptions were made regarding the number of international normalised ratio monitoring tests for patients on warfarin, and the ICER is estimated to decrease by as much as 15.7% under less stringent assumptions. A robust sensitivity analysis was also performed.
Conclusion. Dabigatran as first-line treatment compared with warfarin for the use of stroke prevention in patients with AF is deemed cost-effective when used in accordance with its registered indication in the SA private sector.
M Bergh, HEXOR (Pty) Ltd, Block J, Central Park, 400 16th Road, Midrand, Gauteng
C A Marais, HEXOR (Pty) Ltd, Block J, Central Park, 400 16th Road, Midrand, Gauteng
H Miller-Jansön, HEXOR (Pty) Ltd, Block J, Central Park, 400 16th Road, Midrand, Gauteng
F Salie, Boehringer Ingelheim South Africa, Private Bag X3032, Randburg, 2125
M P Stander, HEXOR (Pty) Ltd, Block J, Central Park, 400 16th Road, Midrand, Gauteng
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Date published: 2013-02-15
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