Cost-effectiveness of dabigatran for stroke prevention in atrial fibrillation in Switzerland

Pletscher, Mark; Plessow, Rafael; Eichler, Klaus; Wieser, Simon

doi:10.4414/smw.2013.13732

Cited by 25 publications

(24 citation statements)

References 34 publications

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“…Twelve studies with single technology assessments of dabigatran compared with VKAs covering eight countries were identified in PubMed. Among these, six studies [33][34][35][36][37][38] adapted the model from Sorensen et al [10] and assessed the cost-effectiveness of dabigatran 150 or 110 mg bid according to age. The other studies assessed different treatment courses, including assessing 150 and 110 mg bid separately, comparing dabigatran to warfarin, aspirin and clopidogrel, or focusing on sub-groups based on age or risk level measured by CHADS 2 score [39][40][41][42][43].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of dabigatran versus vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation: A French payer perspective

Chevalier

Delaitre

Hammès

et al. 2014

Archives of Cardiovascular Diseases

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of dabigatran versus vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation: A French payer perspective

Chevalier

Delaitre

Hammès

et al. 2014

Archives of Cardiovascular Diseases

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“…Not only would large quantities of therapy changes challenge patients and clinicians, but the mass of new NOAC prescription would also have relevant economic influence on the country's obligatory health insurance system covering anticoagulant treatment. It has been shown that NOACs can be cost-effective in specific settings despite higher pharmaceutical costs, because overall costs for anticoagulation related outpatient visits and hospitalizations were reduced compared to warfarin treatment [80][81][82][83][84]. However, just like clinical outcomes, also cost-efficiency estimations have been demonstrated to depend on TTR levels achieved in the VKA group [85,86].…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

Djalali

Valeri

Gerber

et al. 2016

Clin Appl Thromb Hemost

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BACKGROUND: In randomized controlled trials, non-vitamin K antagonist oral anticoagulants (NOACs) demonstrated noninferiority to vitamin K antagonists (VKAs) in patients who spent limited time in therapeutic range (TTR). In real-life patients, TTR is known to vary significantly across countries and health-care settings. OBJECTIVE: We aim to evaluate the quality of VKA treatment in Swiss primary care (PC) by comparing patients' median TTR to levels achieved in the phase III NOAC trials RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48. Patient characteristics affecting TTR control shall be estimated. METHODS: This is a retrospective longitudinal study in Swiss PC patients receiving VKA for 6 months. We identified patients from the PC research database FIRE (Family medicine International Classification of Primary Care Research using Electronic medical records) and calculated TTR according to Rosendaal formula. Comparative data from NOAC trials were retrieved from medical literature. Linear regression models were used to assess predictors of TTR. RESULTS: Primary care encounters of 215 patients were analyzed. Like in the NOAC trials, median observation period was 2.2 years, but patients were older (67.9% vs 38% 75 years) and differed in terms of concomitant diseases and drugs. Median TTR was 75% (65% in the NOAC trials). Female sex was independently associated with a lower TTR and significantly modified by increasing age. CONCLUSION: Practitioners should consider that patients in NOAC trials are only partly representative of PC patients, particularly in terms of TTR control. Only a minority of the observed patients would require a therapy switch to NOACs due to inadequate TTR. Further research is needed in order to identify specific features of care management that are associated with these outcomes.

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“…In this study, dabigatran was superior to warfarin in terms of quality-adjusted life years and the incremental cost-effectiveness ratio [31]. Similarly, in another study, the higher cost of dabigatran was negated by savings in INR monitoring and a lower cost of clinical events than with warfarin [32]. …”

Section: Introductionmentioning

confidence: 98%

New Oral Anticoagulants: Great Promise for Therapeutic Advance but Great Knowledge Gaps Remain to Be Filled

Innasimuthu¹,

Kumar²,

Akter³

et al. 2013

Cardiology

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Cost-effectiveness of dabigatran for stroke prevention in atrial fibrillation in Switzerland

Abstract: Dabigatran can be considered cost-effective in comparison with vitamin K antagonists in the Swiss context. The higher drug cost of dabigatran is compensated by savings in INR monitoring, lower cost of clinical events and QALY-gains.

Cited by 25 publications

References 34 publications

Cost-effectiveness of dabigatran versus vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation: A French payer perspective

Cost-effectiveness of dabigatran versus vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation: A French payer perspective

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

New Oral Anticoagulants: Great Promise for Therapeutic Advance but Great Knowledge Gaps Remain to Be Filled

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