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Cost-Effectiveness of Dabigatran versus Genotype-Guided Management of Warfarin Therapy for Stroke Prevention in Patients with Atrial Fibrillation

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  • Joyce H S You
  • Kia K N Tsui
  • Raymond S M Wong
  • Gergory Cheng

Abstract

Background: Dabigatran is associated with lower rate of stroke comparing to warfarin when anticoagulation control is sub-optimal. Genotype-guided warfarin dosing and management may improve patient-time in target range (TTR) and therefore affect the cost-effectiveness of dabigatran compared with warfain. We examined the cost-effectiveness of dabigatran versus warfarin therapy with genotype-guided management in patients with atrial fibrillation (AF). Methodology/Principal Findings: A Markov model was designed to compare life-long economic and treatment outcomes of dabigatran (110 mg and 150 mg twice daily), warfarin usual anticoagulation care (usual AC) with mean TTR 64%, and genotype-guided anticoagulation care (genotype-guided AC) in a hypothetical cohort of AF patients aged 65 years old with CHADS2 score 2. Model inputs were derived from literature. The genotype-guided AC was assumed to achieve TTR = 78.9%, adopting the reported TTR achieved by warfarin service with good anticoagulation control in literature. Outcome measure was incremental cost per quality-adjusted life-year (QALY) gained (ICER) from perspective of healthcare payers. In base-case analysis, dabigatran 150 mg gained higher QALYs than genotype-guided AC (10.065QALYs versus 9.554QALYs) at higher cost (USD92,684 versus USD85,627) with ICER = USD13,810. Dabigatran 110 mg and usual AC gained less QALYs but cost more than dabigatran 150 mg and genotype-guided AC, respectively. ICER of dabigatran 150 mg versus genotype-guided AC would be >USD50,000 (and genotype-guided AC would be most cost-effective) when TTR in genotype-guided AC was >77% and utility value of warfarin was the same or higher than that of dabigatran. Conclusions/Significance: The likelihood of genotype-guided anticoagulation service to be accepted as cost-effective would increase if the quality of life on warfarin and dabigatran therapy are compatible and genotype-guided service achieves high TTR (>77%).

Suggested Citation

  • Joyce H S You & Kia K N Tsui & Raymond S M Wong & Gergory Cheng, 2012. "Cost-Effectiveness of Dabigatran versus Genotype-Guided Management of Warfarin Therapy for Stroke Prevention in Patients with Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-9, June.
    • Handle: RePEc:plo:pone00:0039640
    DOI: 10.1371/journal.pone.0039640
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    References listed on IDEAS

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    1. Brendan L Limone & William L Baker & Jeffrey Kluger & Craig I Coleman, 2013. "Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation: A Systematic Review of Cost-Effectiveness Models," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-15, April.
    2. Elizabeth J J Berm & Margot de Looff & Bob Wilffert & Cornelis Boersma & Lieven Annemans & Stefan Vegter & Job F M van Boven & Maarten J Postma, 2016. "Economic Evaluations of Pharmacogenetic and Pharmacogenomic Screening Tests: A Systematic Review. Second Update of the Literature," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-22, January.
    3. Yuesong Pan & Qidong Chen & Xingquan Zhao & Xiaoling Liao & Chunjuan Wang & Wanliang Du & Gaifen Liu & Liping Liu & Chunxue Wang & Yilong Wang & Yongjun Wang & for the TIMS-CHINA investigators, 2014. "Cost-Effectiveness of Thrombolysis within 4.5 Hours of Acute Ischemic Stroke in China," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.

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