Why the study?
Does dabigatran improve cost-effectiveness compared to warfarin managed in an anticoagulant clinic for stroke prevention in older AF patients?
Does dabigatran improve cost-effectiveness compared to warfarin managed in an anticoagulant clinic for stroke prevention in older AF patients?
In a decision tree model, substituting dabigatran for warfarin managed in an anticoagulant clinic was not considered cost-effective for stroke prevention in older AF patients based on acceptable willingness-to-pay thresholds.
Not cost-effective at modeled thresholds; leaves open real-world value of unmonitored dabigatran versus clinic-managed warfarin in older AF.
OBJECTIVES: To assess cost effectiveness of anticoagulant clinics after FDA approval of New Oral Anticoagulants (NOACs) for preventing ischemic stroke in Atrial Fibrillation (AF) patients in the United States. METHODS: A decision tree was built to compare cost and effectiveness of 150mg dabigatran twice a day to adjusted dose of warfarin within anticoagulation clinic. The analysis was for one year using a societal perspective. The population in this analysis was a cohort of AF patients, ≥ 65 years old, with a CHADS2 score>2, and no contraindication to anticoagulation. RESULTS: The base case analysis showed that changing from warfarin with anticoagulant clinic to dabigatran without monitoring resulted in an additional $82,793 per QALY saved. Sensitivity analyses found that the model was sensitive to utilities of patients on warfarin. CONCLUSION: This study showed that substituting dabigatran for warfarin in this population was not within acceptable willingness to pay values for new therapy.
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Mai Alhazami (2015) studied this question.
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