Budget and Health Impacts of Switching Atrial Fibrillation Patients to Dabigatran, Taking INR Control, Unique Dosing-Evidence and Product Lifecycle Outcomes Explicitly into Account
Author(s)
Boersma C1, de Jong L2, Wammes K3, Kappelhoff B3, van Hulst M4, Postma M4
1Health-Ecore, Zeist; University of Groningen, University Medical Center Groningen; National Antibiotic Development Platform (NADP), Utrecht, Zeist, UT, Netherlands, 2University of Groningen, Groningen, GR, Netherlands, 3Boehringer Ingelheim, Amsterdam, Netherlands, 4University of Groningen, University Medical Center Groningen, Groningen, Netherlands
OBJECTIVES: Switching patients with atrial fibrillation (AF) from vitamin K antagonists (VKAs) to new oral anticoagulants (NOACs), results in better health outcomes. AF patients on VKAs with regular International Normalized Ratio (INR) control measurements indicating poor control, benefit most from such a switch. The unique well-studied reduced dosing-evidence for dabigatran and the approaching loss of market exclusivity, could lead to cost-savings. This study assessed the health benefits and budget impacts of switching AF-patients to dabigatran in the Netherlands. METHODS: A health and budget impact model was developed to assess the impact of switching AF-patients on VKA’s (only poor INR control) to dabigatran. Risks for clinical events (e.g. stroke, bleedings) and mortality were derived from clinical trials. Cost estimates were based on recently published data for the Netherlands. Different switch scenarios that included optimised and individualised standard and reduced dosing benefits for dabigatran and loss of exclusivity impact, were analysed. A 5-years’ time-horizon was applied. Extensive sensitivity analysis for costs and risks was performed. RESULTS: Switch of VKA (poor INR control) to dabigatran resulted in a 13.3% (event rate change from 0.41 to 35.6) and 35.2% (mortality rate change from 0.27 to 0.17) reduction in clinical events and mortality over a 5-years period, respectively. The reduction in clinical events was associated with per patient cost-savings for dabigatran treatment of €698. Total per patient cost-savings – including cost differences for treatment and INR control were estimated at €760. A 25% reduction of the dabigatran price would result in per patient cost-savings of €2,412. Health benefits and related cost-savings for patients eligible for the reduced dabigatran dose, were even more favourable. CONCLUSIONS: This study provides evidence that different VKA to dabigatran switch scenarios lead to substantial health benefits and cost-savings. Therefore, dabigatran could be considered as the most favourable treatment option on the short- and long-term.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PDG19
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Budget Impact Analysis, Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders