Abstract 17410: A Multiperspective Analysis of the Influence of Medicare Part D on the Cost-effectiveness of Dabigatran versus Warfarin
Introduction: Dabigatran and warfarin have been shown to be non-inferior for stroke prevention in atrial fibrillation (AF). We aimed to assess the cost perspectives of each payer (Medicare and patient) in relation to administration, monitoring and adverse outcomes for each medication.
Hypothesis: We hypothesize that dabigatran 150 mg BID will be more cost-effective when compared to warfarin for both payers (Medicare and patient) regardless of Medicare Part D coverage.
Methods: Using a Markov model, we performed a decision analysis comparing two treatment strategies in patients 65 years of age and older with AF: adjusted-dose warfarin and dabigatran 150 mg twice daily in Medicare patients with CHADS2 scores ≥ 1. Results are listed in 2013 US dollars, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). Patient movement between health states was modeled using 1-month cycles for 35 years or until death. Cost-effectiveness therapies were selected using a willingness to pay threshold of $50,000 per quality-adjusted life year gained.
Results: For patients with Medicare Part D coverage, Quality-adjusted life expectancy was 10.74 QALYs with warfarin and 11.22 QALYs with 150 mg dabigatran BID. From Medicare’s perspective, total average costs were $59,684 and $59,284 for warfarin as well as $76,237 and $45,421 for dabigatran, in patients with and without Part D coverage, respectively. From Medicare’s perspective, the ICER comparing dabigatran with warfarin was $34,707 and -$29,065, for patients with and without Part D coverage, respectively. From the patient’s perspective, total costs were $33,466 and $33,866 for warfarin as well as $28,876 and $59,692 for dabigatran, in patients with and without Part D coverage, respectively. From the patient’s perspective, the ICER comparing dabigatran with warfarin was -$9,624 and $54,147, for patients with and without Part D coverage, respectively.
Conclusions: In patients ≥ 65 years old with nonvalvular atrial fibrillation (NVAF) and at increased risk of stroke (CHAD2 score = 2), dabigatran 150 mg BID is more cost-effective for both Medicare and the patient, except for individual patients without Medicare Part D coverage.
Author Disclosures: B.M. Salata: None. D.W. Hutton: None. D.A. Levine: None. J.B. Froehlich: None. G.D. Barnes: None.
- © 2014 by American Heart Association, Inc.