Cost-effectiveness of Dabigatran and Rivaroxaban Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation

Ye Wang, Feng Xie, Ming Chai Kong, Lai Heng Lee, Heng Joo Ng, Yu Ko

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose: This study aimed to evaluate the cost-effectiveness of dabigatran and rivaroxaban compared with warfarin for the prevention of stroke in patients with atrial fibrillation (AF) in Singapore.

Methods: A Markov model was constructed to compare the lifetime costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) of dabigatran 110 and 150 mg, rivaroxaban 20 mg and adjusted-dose warfarin from the perspective of the Singapore healthcare system, using clinical data from published studies, utilities from a patient-reported survey and costs from hospital databases. The target population was a hypothetical cohort of 65-year-old AF patients with no contraindications to anticoagulation.

Results: In the base-case analysis, the QALYs were 8.75 with warfarin, 8.73 with dabigatran 110 mg, 8.82 with dabigatran 150 mg, and 9.33 with rivaroxaban. The costs were Singapore dollar (SG$) 34,648 for warfarin, SG$54,919 for dabigatran 110 mg, SG$50,484 for dabigatran 150 mg and SG$51,975 for rivaroxaban. The ICER of rivaroxaban versus warfarin was SG$29,697 (US$26,727) per QALY. Rivaroxaban and warfarin had extended dominance over the high-dose dabigatran. The low-dose dabigatran was dominated by warfarin. Deterministic sensitivity analyses showed that the ICER of rivaroxaban versus warfarin was sensitive to cost of rivaroxaban and utilities for rivaroxaban and warfarin. Probability sensitivity analysis demonstrated that the probability of rivaroxaban being the optimal choice was 97.8 % and 99.5 % at a willingness-to-pay threshold of SG$65,000 (US$58,500) and SG$130,000 (US$117,000) per QALY, respectively.

Conclusion: Rivaroxaban may be a cost-effective alternative to warfarin for the prevention of stroke in patients with AF in Singapore.

Original languageEnglish
Pages (from-to)575-585
Number of pages11
JournalCardiovascular Drugs and Therapy
Volume28
Issue number6
DOIs
Publication statusPublished - Dec 9 2014
Externally publishedYes

Fingerprint

Warfarin
Atrial Fibrillation
Cost-Benefit Analysis
Stroke
Quality-Adjusted Life Years
Singapore
Costs and Cost Analysis
Rivaroxaban
Dabigatran
Hospital Costs
Health Services Needs and Demand
Databases
Delivery of Health Care

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Cost-effectiveness
  • Dabigatran
  • Rivaroxaban
  • Warfarin

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Cardiology and Cardiovascular Medicine
  • Pharmacology
  • Medicine(all)

Cite this

Cost-effectiveness of Dabigatran and Rivaroxaban Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation. / Wang, Ye; Xie, Feng; Kong, Ming Chai; Lee, Lai Heng; Ng, Heng Joo; Ko, Yu.

In: Cardiovascular Drugs and Therapy, Vol. 28, No. 6, 09.12.2014, p. 575-585.

Research output: Contribution to journalArticle

Wang, Ye ; Xie, Feng ; Kong, Ming Chai ; Lee, Lai Heng ; Ng, Heng Joo ; Ko, Yu. / Cost-effectiveness of Dabigatran and Rivaroxaban Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation. In: Cardiovascular Drugs and Therapy. 2014 ; Vol. 28, No. 6. pp. 575-585.
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abstract = "Purpose: This study aimed to evaluate the cost-effectiveness of dabigatran and rivaroxaban compared with warfarin for the prevention of stroke in patients with atrial fibrillation (AF) in Singapore.Methods: A Markov model was constructed to compare the lifetime costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) of dabigatran 110 and 150 mg, rivaroxaban 20 mg and adjusted-dose warfarin from the perspective of the Singapore healthcare system, using clinical data from published studies, utilities from a patient-reported survey and costs from hospital databases. The target population was a hypothetical cohort of 65-year-old AF patients with no contraindications to anticoagulation.Results: In the base-case analysis, the QALYs were 8.75 with warfarin, 8.73 with dabigatran 110 mg, 8.82 with dabigatran 150 mg, and 9.33 with rivaroxaban. The costs were Singapore dollar (SG$) 34,648 for warfarin, SG$54,919 for dabigatran 110 mg, SG$50,484 for dabigatran 150 mg and SG$51,975 for rivaroxaban. The ICER of rivaroxaban versus warfarin was SG$29,697 (US$26,727) per QALY. Rivaroxaban and warfarin had extended dominance over the high-dose dabigatran. The low-dose dabigatran was dominated by warfarin. Deterministic sensitivity analyses showed that the ICER of rivaroxaban versus warfarin was sensitive to cost of rivaroxaban and utilities for rivaroxaban and warfarin. Probability sensitivity analysis demonstrated that the probability of rivaroxaban being the optimal choice was 97.8 {\%} and 99.5 {\%} at a willingness-to-pay threshold of SG$65,000 (US$58,500) and SG$130,000 (US$117,000) per QALY, respectively.Conclusion: Rivaroxaban may be a cost-effective alternative to warfarin for the prevention of stroke in patients with AF in Singapore.",
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AU - Ng, Heng Joo

AU - Ko, Yu

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N2 - Purpose: This study aimed to evaluate the cost-effectiveness of dabigatran and rivaroxaban compared with warfarin for the prevention of stroke in patients with atrial fibrillation (AF) in Singapore.Methods: A Markov model was constructed to compare the lifetime costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) of dabigatran 110 and 150 mg, rivaroxaban 20 mg and adjusted-dose warfarin from the perspective of the Singapore healthcare system, using clinical data from published studies, utilities from a patient-reported survey and costs from hospital databases. The target population was a hypothetical cohort of 65-year-old AF patients with no contraindications to anticoagulation.Results: In the base-case analysis, the QALYs were 8.75 with warfarin, 8.73 with dabigatran 110 mg, 8.82 with dabigatran 150 mg, and 9.33 with rivaroxaban. The costs were Singapore dollar (SG$) 34,648 for warfarin, SG$54,919 for dabigatran 110 mg, SG$50,484 for dabigatran 150 mg and SG$51,975 for rivaroxaban. The ICER of rivaroxaban versus warfarin was SG$29,697 (US$26,727) per QALY. Rivaroxaban and warfarin had extended dominance over the high-dose dabigatran. The low-dose dabigatran was dominated by warfarin. Deterministic sensitivity analyses showed that the ICER of rivaroxaban versus warfarin was sensitive to cost of rivaroxaban and utilities for rivaroxaban and warfarin. Probability sensitivity analysis demonstrated that the probability of rivaroxaban being the optimal choice was 97.8 % and 99.5 % at a willingness-to-pay threshold of SG$65,000 (US$58,500) and SG$130,000 (US$117,000) per QALY, respectively.Conclusion: Rivaroxaban may be a cost-effective alternative to warfarin for the prevention of stroke in patients with AF in Singapore.

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KW - Atrial fibrillation

KW - Cost-effectiveness

KW - Dabigatran

KW - Rivaroxaban

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