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.