Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation? A critically appraised topic

Amelia K. Adcock, Joyce K. Lee-Iannotti, Maria I. Aguilar, Charlene R. Hoffman-Snyder, Dean Marko Wingerchuk, Kay E. Wellik, Bart M Demaerschalk

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: Warfarin has provided protection against cardioembolic stroke in the setting of nonvalvular atrial fibrillation (NVAF) for the past 60 years. Dabigatran, the first oral direct thrombin inhibitor to be approved in the United States, promises to provide the same or better stroke protection with reduced risk of intracranial hemorrhage. However, it remains to be seen whether grand-scale adoption of dabigatran will be cost effective. OBJECTIVE: To critically assess current evidence regarding the cost effectiveness of dabigatran for preventing stroke in patients with NVAF compared with warfarin. METHODS: The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. RESULTS: A cost-effectiveness analysis (CEA) that followed a hypothetical cohort of NVAF patients 65 years of age or older and CHADS2≥1 over their lifetime comparing dabigatran with adjusted-dose warfarin was reviewed. Assuming a willingness to pay a threshold of $50,000 per quality-adjusted life year (QALY), base case results favored high-dose (150 mg bid) dabigatran as a cost-effective alternative to warfarin. Sensitivity analysis asserted that the cost effectiveness of dabigatran improved if it could be obtained for ≤$13/d or if it was used in populations with high risk of stroke or intracranial hemorrhage. CONCLUSIONS: Dabigatran 150 mg bid ($12,286 per QALY) is a cost-effective alternative to International Normalized Ratio-adjusted warfarin for the prevention of ischemic stroke in patients 65 years of age or older with NVAF.

Original languageEnglish (US)
Pages (from-to)102-107
Number of pages6
JournalNeurologist
Volume18
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

Warfarin
Atrial Fibrillation
Stroke
Costs and Cost Analysis
Cost-Benefit Analysis
Quality-Adjusted Life Years
Intracranial Hemorrhages
Librarians
International Normalized Ratio
Antithrombins
Neurology
Consultants
Dabigatran
Blood Vessels
Population

Keywords

  • anticoagulants
  • atrial fibrillation
  • critically appraised topic
  • dabigatran
  • evidence-based medicine
  • healthcare costs
  • healthcare rationing
  • medical economics
  • stroke
  • warfarin

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation? A critically appraised topic. / Adcock, Amelia K.; Lee-Iannotti, Joyce K.; Aguilar, Maria I.; Hoffman-Snyder, Charlene R.; Wingerchuk, Dean Marko; Wellik, Kay E.; Demaerschalk, Bart M.

In: Neurologist, Vol. 18, No. 2, 03.2012, p. 102-107.

Research output: Contribution to journalArticle

Adcock, Amelia K. ; Lee-Iannotti, Joyce K. ; Aguilar, Maria I. ; Hoffman-Snyder, Charlene R. ; Wingerchuk, Dean Marko ; Wellik, Kay E. ; Demaerschalk, Bart M. / Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation? A critically appraised topic. In: Neurologist. 2012 ; Vol. 18, No. 2. pp. 102-107.
@article{5af660a05c204c9b8440147cea6b3555,
title = "Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation? A critically appraised topic",
abstract = "BACKGROUND: Warfarin has provided protection against cardioembolic stroke in the setting of nonvalvular atrial fibrillation (NVAF) for the past 60 years. Dabigatran, the first oral direct thrombin inhibitor to be approved in the United States, promises to provide the same or better stroke protection with reduced risk of intracranial hemorrhage. However, it remains to be seen whether grand-scale adoption of dabigatran will be cost effective. OBJECTIVE: To critically assess current evidence regarding the cost effectiveness of dabigatran for preventing stroke in patients with NVAF compared with warfarin. METHODS: The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. RESULTS: A cost-effectiveness analysis (CEA) that followed a hypothetical cohort of NVAF patients 65 years of age or older and CHADS2≥1 over their lifetime comparing dabigatran with adjusted-dose warfarin was reviewed. Assuming a willingness to pay a threshold of $50,000 per quality-adjusted life year (QALY), base case results favored high-dose (150 mg bid) dabigatran as a cost-effective alternative to warfarin. Sensitivity analysis asserted that the cost effectiveness of dabigatran improved if it could be obtained for ≤$13/d or if it was used in populations with high risk of stroke or intracranial hemorrhage. CONCLUSIONS: Dabigatran 150 mg bid ($12,286 per QALY) is a cost-effective alternative to International Normalized Ratio-adjusted warfarin for the prevention of ischemic stroke in patients 65 years of age or older with NVAF.",
keywords = "anticoagulants, atrial fibrillation, critically appraised topic, dabigatran, evidence-based medicine, healthcare costs, healthcare rationing, medical economics, stroke, warfarin",
author = "Adcock, {Amelia K.} and Lee-Iannotti, {Joyce K.} and Aguilar, {Maria I.} and Hoffman-Snyder, {Charlene R.} and Wingerchuk, {Dean Marko} and Wellik, {Kay E.} and Demaerschalk, {Bart M}",
year = "2012",
month = "3",
doi = "10.1097/NRL.0b013e318247bcb6",
language = "English (US)",
volume = "18",
pages = "102--107",
journal = "Neurologist",
issn = "1074-7931",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Is dabigatran cost effective compared with warfarin for stroke prevention in atrial fibrillation? A critically appraised topic

AU - Adcock, Amelia K.

AU - Lee-Iannotti, Joyce K.

AU - Aguilar, Maria I.

AU - Hoffman-Snyder, Charlene R.

AU - Wingerchuk, Dean Marko

AU - Wellik, Kay E.

AU - Demaerschalk, Bart M

PY - 2012/3

Y1 - 2012/3

N2 - BACKGROUND: Warfarin has provided protection against cardioembolic stroke in the setting of nonvalvular atrial fibrillation (NVAF) for the past 60 years. Dabigatran, the first oral direct thrombin inhibitor to be approved in the United States, promises to provide the same or better stroke protection with reduced risk of intracranial hemorrhage. However, it remains to be seen whether grand-scale adoption of dabigatran will be cost effective. OBJECTIVE: To critically assess current evidence regarding the cost effectiveness of dabigatran for preventing stroke in patients with NVAF compared with warfarin. METHODS: The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. RESULTS: A cost-effectiveness analysis (CEA) that followed a hypothetical cohort of NVAF patients 65 years of age or older and CHADS2≥1 over their lifetime comparing dabigatran with adjusted-dose warfarin was reviewed. Assuming a willingness to pay a threshold of $50,000 per quality-adjusted life year (QALY), base case results favored high-dose (150 mg bid) dabigatran as a cost-effective alternative to warfarin. Sensitivity analysis asserted that the cost effectiveness of dabigatran improved if it could be obtained for ≤$13/d or if it was used in populations with high risk of stroke or intracranial hemorrhage. CONCLUSIONS: Dabigatran 150 mg bid ($12,286 per QALY) is a cost-effective alternative to International Normalized Ratio-adjusted warfarin for the prevention of ischemic stroke in patients 65 years of age or older with NVAF.

AB - BACKGROUND: Warfarin has provided protection against cardioembolic stroke in the setting of nonvalvular atrial fibrillation (NVAF) for the past 60 years. Dabigatran, the first oral direct thrombin inhibitor to be approved in the United States, promises to provide the same or better stroke protection with reduced risk of intracranial hemorrhage. However, it remains to be seen whether grand-scale adoption of dabigatran will be cost effective. OBJECTIVE: To critically assess current evidence regarding the cost effectiveness of dabigatran for preventing stroke in patients with NVAF compared with warfarin. METHODS: The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of vascular neurology. RESULTS: A cost-effectiveness analysis (CEA) that followed a hypothetical cohort of NVAF patients 65 years of age or older and CHADS2≥1 over their lifetime comparing dabigatran with adjusted-dose warfarin was reviewed. Assuming a willingness to pay a threshold of $50,000 per quality-adjusted life year (QALY), base case results favored high-dose (150 mg bid) dabigatran as a cost-effective alternative to warfarin. Sensitivity analysis asserted that the cost effectiveness of dabigatran improved if it could be obtained for ≤$13/d or if it was used in populations with high risk of stroke or intracranial hemorrhage. CONCLUSIONS: Dabigatran 150 mg bid ($12,286 per QALY) is a cost-effective alternative to International Normalized Ratio-adjusted warfarin for the prevention of ischemic stroke in patients 65 years of age or older with NVAF.

KW - anticoagulants

KW - atrial fibrillation

KW - critically appraised topic

KW - dabigatran

KW - evidence-based medicine

KW - healthcare costs

KW - healthcare rationing

KW - medical economics

KW - stroke

KW - warfarin

UR - http://www.scopus.com/inward/record.url?scp=84858144929&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84858144929&partnerID=8YFLogxK

U2 - 10.1097/NRL.0b013e318247bcb6

DO - 10.1097/NRL.0b013e318247bcb6

M3 - Article

VL - 18

SP - 102

EP - 107

JO - Neurologist

JF - Neurologist

SN - 1074-7931

IS - 2

ER -