Cost-Effectiveness of Dabigatran for Thromboembolic Events Prevention in Atrial Fibrillation Patients

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation patients.

METHODS: The population was modeled using a Markov cohort model that describes the natural history of a patient with AF in terms of the consequences derived from the occurrence of ischemic/hemorrhagic events. Regarding the occurrence of major events, two major sources were used to populate the model: the RE-LY trial and the network meta-analysis (NMA) published by Lopez-Lopez et al. Direct costs measured as Chilean pesos (1 USD = 710.9 CLP) were obtained from local tariff sources, whereas utilities were obtained from the literature. Deterministic and Probabilistic sensitive analysis were performed. An additional scenario-analysis explored the use of Idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting.

RESULTS: Dabigatran was the most effective among all the alternatives (8.53 QALYs). In consideration of the Chilean threshold of USD 17.200 (1 GDP per capita), Dabigatran is cost-effective (USD 11.042 per QALY gained) and either Rivaroxaban or Apixaban are dominated by Dabigatran. Regarding the second-order uncertainty, at the suggested threshold dabigatran exhibit the major probability of being cost-effective (approximately 0.6). The reversal agent scenario indicates that dabigatran plus idarucizumab is also cost-effective for the Chilean setting.

CONCLUSIONS: This study concludes that dabigatran is cost-effective and both, rivaroxaban/apixaban, are dominated by dabigratran. In addition, dabigatran-idatucizumab is also cost-effective when is compared against acenocoumarol-CCPP.