Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping SE-581 83, Sweden.
Eur Heart J. 2013 Jan;34(3):177-83. doi: 10.1093/eurheartj/ehs157. Epub 2012 Jun 24.
Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden.
A decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is €2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at €7742, increasing to €12 449 if dabigatran is compared with only well-controlled warfarin treatment.
Dabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.
房颤患者发生血栓栓塞性事件（如缺血性中风）的风险显著增加，因此建议此类患者接受抗凝治疗。最常用的抗凝药物包括华法林等维生素 K 拮抗剂。一种新型口服抗凝药物达比加群酯最近已获准用于房颤患者的卒中预防。本研究旨在评估达比加群酯与华法林相比，用于预防瑞典 65 岁房颤患者卒中及血栓栓塞性事件的成本-效果。
采用决策分析模拟模型估算了不同治疗方案的长期（20 年）成本和效果。结局指标为预防的卒中数、生存年数和质量调整生命年（QALY）。成本和效果数据均调整至瑞典情况。年龄低于 80 岁的患者假定起始服用达比加群酯 150 mg，每日 2 次，80 岁后因出血风险增加改为 110 mg，每日 2 次。达比加群酯在瑞典的价格为每天 2.82 欧元（瑞典克朗 25.39），两种剂量均相同。与华法林相比，达比加群酯每获得一个 QALY 的成本估计为 7742 欧元，如果与仅控制良好的华法林治疗相比，这一数字则增至 12449 欧元。
达比加群酯在瑞典具有成本效果，因为其增量成本效果比低于通常可接受的支付意愿界限。
