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Titel: Cost-effectiveness of dabigatran for stroke prevention in atrial fibrillation in Switzerland
Autor/-in: Pletscher, Mark
Plessow, Rafael
Eichler, Klaus
Wieser, Simon
Erschienen in: Swiss medical weekly
Band(Heft): 2013
Heft: 143
Seiten: 1
Seiten bis: 12
Verlag / Hrsg. Institution: EMH Schweizerischer Ärzteverlag
Erscheinungsdatum: 2013
Lizenz (gemäss Verlagsvertrag): CC BY-NC-ND 4.0: Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International
Art der Begutachtung: Peer review (Publikation)
Sprache: Englisch
Schlagwörter: Antifibrinolytic agents; Antithrombins; Atrial fibrillation; Benzimidazoles; Cost-benefit analysis; Dabigatran; Drug dose-response relationship; Markov chains; Quality of life; Quality-adjusted life years; Stroke; Vitamin K; Beta-Alanine
Fachgebiet (DDC): 362: Gesundheits- und Sozialdienste
Zusammenfassung: OBJECTIVES: Atrial fibrillation is a major risk factor for ischemic stroke and anticoagulation therapy is indicated to reduce risk. Dabigatran is a new oral anticoagulant that does not require INR monitoring. This study evaluated the cost-effectiveness of dabigatran versus vitamin K antagonists for stroke prevention in atrial fibrillation in Switzerland. METHODS: A Markov model simulating the course of treatment and occurrence of clinical events in two treatment arms over the lifetime of patients was adapted to the Swiss context. The adaptation included the cost of anticoagulation therapy and clinical events in Switzerland. The cost of inpatient care was estimated on data of all inpatient hospital stays in 2008. The calculation of outpatient care costs was based on peer reviewed studies, expert interviews and local tariffs. RESULTS: Patients treated with dabigatran had a higher life expectancy and experienced more quality adjusted life years (QALY) while incurring higher costs than patients treated with vitamin K antagonists. The estimated incremental cost-effectiveness ratio (ICER) was CHF 25,108.‒ per QALY with 110 mg and CHF 9,702 per QALY with 150 mg of dabigatran. A sequential dosage scheme, in which 150 mg are administered up to the age of 80 years and 110 mg thereafter, resulted in an ICER of CHF 10,215 per QALY. A sensitivity analysis confirmed that these results are robust. CONCLUSIONS: 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.
Departement: School of Management and Law
Organisationseinheit: Winterthurer Institut für Gesundheitsökonomie (WIG)
Publikationstyp: Beitrag in wissenschaftlicher Zeitschrift
DOI: 10.21256/zhaw-4681
10.4414/smw.2013.13732
ISSN: 1424-7860
1424-3997
0036-7672
URI: https://digitalcollection.zhaw.ch/handle/11475/9101
Enthalten in den Sammlungen:Publikationen School of Management and Law

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