Abstract 14964: Cost-Effectiveness of Dabigatran Etexilate versus Rivaroxaban for Stroke and Systemic Embolism Risk Reduction in Atrial Fibrillation: A US Third Party Payer Perspective
Objectives In the US, dabigatran etexilate (dabigatran) and rivaroxaban are two new treatments for reducing risk of stroke and systemic embolism (SE) in patients with non-valvular atrial fibrillation (NVAF). Based on the RE-LY and ROCKET AF trial results, we investigated the cost-effectiveness of dabigatran 150mg bid versus rivaroxaban from a US payer perspective.
Methods A previously published Markov model was adapted to simulate anticoagulation treatment and clinical events including: stroke, SE, transient ischemic attack, hemorrhage (intracranial (ICH), extracranial and minor), myocardial infarction (MI), resulting functional disability, death, and treatment discontinuation. The model used results from an indirect treatment comparison (ITC) of dabigatran versus rivaroxaban as inputs. The ITC statistically corrected risk estimates for differences between the trial populations and the performance of the warfarin arms (time in therapeutic range was 9% lower in ROCKET AF) using the safety on treatment analysis sets (events while on treatment in patients receiving ≥one dose) for both studies. Event and disability costs were calculated using Medicare reimbursement data. Model outputs included event rates, total costs, and quality-adjusted life-years (QALYs).
Results The ITC found dabigatran had a lower risk of ICH (RR = 0.41; 95%CI 0.23- 0.72), ischemic stroke (RR = 0.67; 95%CI 0.46-0.98) and major bleedings (RR = 0.82; 95%CI 0.67 - 0.99) compared to rivaroxaban and a higher risk of MI (RR = 1.47; 95%CI 0.97-2.24). Over a lifetime horizon, the model found dabigatran-treated patients experienced fewer ischemic strokes (2.81 vs. 3.33), ICHs (0.30 vs. 0.60), and extracranial bleeds (2.63 vs. 3.03) (all per 100 patient-years), but more MI (1.76 vs. 1.42). Dabigatran-treated patients accrued more QALYs (6.54 vs. 6.38) with lower lifetime total costs ($36,649 vs. $37,184) due to lower acute and follow-up care costs. In probabilistic sensitivity analysis including warfarin, dabigatran had a high probability of being most cost-effective therapy at common thresholds of willingness-to-pay (98% at a $100,000/QALY).
Conclusions This study found dabigatran economically dominant to rivaroxaban for reducing the risk of stroke and SE among US NVAF patients.
- © 2012 by American Heart Association, Inc.