Ximelagatran Cost Effectiveness for Stroke Prevention in Atrial Fibrillation

Background The benefit of warfarin for stroke prevention in non‐valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a narrow therapeutic window and carries a significant risk of bleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability. Aim To compare the costs and benefits of ximelagatran to that of warfarin and aspirin. Method In a preliminary cost‐effectiveness analysis, the costs and clinical consequences of warfarin, aspirin and ximelagatran were compared. The principal outcome was measured in the form of an incremental cost‐effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data. Results Warfarin appeared to be most cost effective in this clinical setting. The incremental cost‐effectiveness ratio indicated that the use of ximelagatran in preference to warfarin would cost an additional $272 000/patient/year. Likewise the use of ximelagatran in preference to aspirin would cost an additional $13 000/patient/year. Conclusion Ximelagatran appears to be cost effective in a small group of high‐risk patients. This may have implications for the development of treatment guidelines in this clinical setting.