A new health economic analysis, published today online in Thrombosis and Haemostasis, suggested that Boehringer Ingelheim's novel oral direct thrombin inhibitor, dabigatran etexilate, is cost-effective compared to current treatment options, particularly in "real-world" clinical practice.
The cost-effectiveness of dabigatran etexilate was driven by superior prevention of stroke and systemic embolism alongside a reduction in devastating intracranial bleeding compared to well-controlled warfarin, in patients with AF.
In the "real-world" clinical practice setting, dabigatran etexilate was shown to be particularly cost-effective compared to current care. The "real-world" prescribing scenario reflects stroke prophylaxis in warfarin-eligible Canadian patients with AF as observed in actual clinical practice meaning patients could be receiving prophylaxis with warfarin, aspirin, or no treatment at all.
Dr. Stuart Connolly, principal investigator of the RE-LY® study, Director of Cardiology at the Population Health Institute, McMaster University, Hamilton, Ontario, and co-author of the economic evaluation commented, "We want to do the best for patients and dabigatran is the medically preferred treatment for stroke prevention. From the analyses reported today, we now know that it is cost-effective too - good value for our scarce healthcare budget."
Typically healthcare decision makers assess whether new therapies represent good value for money by applying a threshold for additional health benefits (lower considered to be better value). In Canada, a threshold of $30,000 per quality adjusted life year (QALY)-gained is considered acceptable while being conservative.
The results of the health economic analysis showed that the incremental cost-effectiveness ratio (ICER) of dabigatran etexilate was $10,440 / QALY versus "trial-like" warfarin and $3,962 / QALY versus "real-world" warfarin, aspirin or no treatment. This demonstrates that dabigatran etexilate is a cost-effective alternative to current care for the prevention of stroke among Canadian patients with AF.
AF is a leading cause of stroke and is associated with higher mortality and costlier hospital stays than stroke in patients without AF. Additionally, AF is associated with an increased risk of systemic embolism which may result in major damage to limbs and organs (e.g. embolism [blood clot] in an artery).
Exploring the current use and future of alternatives to traditional informed consent in acute stroke trials