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Dabigatran versus warfarin under standard or pharmacogenetic-guided management for the prevention of stroke and systemic thromboembolism in patients with atrial fibrillation: a cost/utility analysis using an analytic decision model


Léon Nshimyumukiza, Julie Duplantie, Mathieu Gagnon, Xavier Douville, Diane Fournier, Carmen Lindsay, Marc Parent, Alain Milot, Yves Giguère, Christian Gagné, François Rousseau and Daniel Reinharz

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Abstract -

Background
Atrial fibrillation (AF) is the most common form of heart arrhythmia and a leading cause of stroke and systemic embolism. Chronic anticoagulation is recommended for preventing those complications. Our study aimed to compare the cost/utility (CU) of three main anticoagulation options: 1) standard warfarin dosing (SD-W) 2) warfarin dosage under the guidance of CYP2C9 and VKORC1 genotyping (GT-W) and 3) dabigatran 150 mg twice a day.

Methods
A Markov state transition model was built to simulate the expected C/U of dabigatran, SD-W and GT-W anticoagulation therapy for the prevention of stroke and systemic thromboembolism in patients with atrial fibrillation over a period of 5 years under the perspective of the public health care system. Model inputs were derived from extensive literature search and government's data bases. Outcomes considered were the number of total major events (thromboembolic and hemorrhagic events), total costs in Canadian dollars (1CAD$ = 1$US), total quality-adjusted life years (QALYs), costs/QALYs and incremental costs/QALYs gained (ICUR).

Results
Raw base case results show that SD-W has the lowest C/U ratio. However, the dabigatran option might be considered as an alternative, as its cost per additional QALY gained compared to SD-W is CAD $ 4 765, i.e. less than 50 000, the ICUR threshold generally accepted to adopt an intervention. At the same threshold, GT-W doesn't appear to be an alternative to SD-W. Our results were robust to one-way and multi-way sensitivity analyses.

Conclusion
SD-W has the lowest C/U ratio among the 3 options. However, dabigatran might be considered as an alternative. GT-W is not C/U and should not currently be recommended for the routine anticoagulotherapy management of AF patients.


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Bibtex:

@article{Giguère983,
    author    = { Léon Nshimyumukiza and Julie Duplantie and Mathieu Gagnon and Xavier Douville and Diane Fournier and Carmen Lindsay and Marc Parent and Alain Milot and Yves Giguère and Christian Gagné and François Rousseau and Daniel Reinharz },
    title     = { Dabigatran versus warfarin under standard or pharmacogenetic-guided management for the prevention of stroke and systemic thromboembolism in patients with atrial fibrillation: a cost/utility analysis using an analytic decision model },
    volume    = { 11 },
    number    = { 14 },
    year      = { 2013 },
    journal   = { Thrombosis Journal },
    web       = { http://dx.doi.org/10.1186/1477-9560-11-14 }
}

Dernière modification: Jul 29 2013 10:26AM par cgagne

     
   
   

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