Cost-effectiveness of dabigatran versus vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation: A French payer perspective

Background. Atrialtbrillation is the main cause of stroke, but the risk can be reduced, usually with vitamin K antagonists (VKAs) such as warfarin. The RE-LY atrial fibrillation study demonstrated that the rates of stroke and systemic embolism with dabigatran (an oral direct thrombin inhibitor) were similar to or lower than those with warfarin. Aims. To estimate the cost-effectiveness, from a French payer perspective, of dabigatran (150 or 110 mg bid for patients < or >= 80 years, respectively) versus warfarin. Methods. Cost-effectiveness was modeled using a Markov model in a cohort of 10,000 patients with atrial fibrillation followed over their lifetime. Events accounted for included ischemic stroke, systemic embolism, transient ischemic attack, hemorrhage, myocardial infarction and death. The model patient population matched the RE-LY patients. Dabigatran was compared with "trial-like" warfarin and "real-world" prescribing. Risks of clinical events were obtained from RE-LY. Event and follow-up costs were based on the French national tariff or published literature. Clinical events, QALYs, total costs and incremental cost-effectiveness ratios (ICERs) were calculated. Results. The ICERs of dabigatran compared with "trial-like" warfarin and "real-world" prescribing were (sic)15,838/QALY and (sic)7473/QALY, respectively. Deterministic and probabilistic sensitivity analyses showed these to be robust to uncertainty and variability in the model parameters. The ICER for dabigatran was below (sic)24,000/QALY or (sic)36,000/QALY in 71% or 92%, respectively, of the simulations when compared with "trial-like" warfarin and 100% and 100%, respectively, when compared with "real-world" prescribing. Conclusion. This study suggests that the use of dabigatran in French atrial fibrillation patients is cost-effective, according to usually accepted thresholds. (C) 2014 Elsevier Masson SAS. All rights reserved.