Pharmacoeconomic evaluation of dabigatran and rivaroxaban in prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillatio

Aim

To evaluate cost-effectiveness of dabigatran and riva roxaban for prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF).

Material and methods

Markov model was developed to compare cost-effectiveness of dabigatran and rivaroxaban using the results of the RE-LY and ROCKET AF clinical trials. A relative risk of each outcome was calculated through an indirect comparison of dabigatran and rivaroxaban with warfarin as a common comparator. Onlydirectmedicalcostswere taken into account. The results of modeling were evaluated from the perspective of the health care system.

Results

A total number of events calculated for a period of 10 yearsfor10 000 patientstreatedwithdabigatran was 15% lower compared with that in patients treated with rivaroxaban (8895 and 10216, respectively). Treatment with dabigatran compared with rivaroxaban prevented more primary and secondary strokes and resulted in a mean gain of 0.269 qualityadjusted life-year within 10 years. Dabigatran administration was associated with lower costs for health care system as a result of decreased costs for unfavorable outcomes, particularly ischemic stroke and intracranial bleeding. Dabigatran had more favorable cost-utility ratio and dominated over rivaro xaban.

Conclusion

Treatment with dabigatran is a cost-saving techonology for health care system compared with rivaroxaban.

Key words

Pharmacoeconomics, dabigatran, rivaroxaban, systemic embolism, nov-valvular atrial fibrillation, ischemic stroke.