van Hulst Marinus, Stevanovic Jelena, Jacobs Maartje S, Tieleman Robert G, Kappelhoff Bregt, Postma Maarten J
a Department of Clinical Pharmacy and Toxicology , Martini Hospital , Groningen , The Netherlands.
b Department of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands.
J Med Econ. 2018 Jan;21(1):38-46. doi: 10.1080/13696998.2017.1372222. Epub 2017 Sep 7.
Atrial fibrillation (AF) causes a significant health and economic burden to the Dutch society. Dabigatran was proven to have at least similar efficacy and a similar or better safety profile when compared to vitamin K antagonists (VKAs) in preventing arterial thromboembolism in patients with AF.
To evaluate the cost-effectiveness and monetary benefit of dabigatran vs VKAs in Dutch patients with non-valvular AF. Value-based pricing considerations and corresponding negotiations on dabigatran will be explicitly considered.
The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the RE-LY trial and Dutch observational data. Univariate, probabilistic sensitivity, and various scenario analyses were performed.
Dabigatran was cost saving compared to VKAs. A total of 4,552 QALYs were gained, and €13,892,288 was saved in a cohort of 10,000 AF patients. The economic value of dabigatran was strongly related to the costs of VKA control that are averted. Notably, dabigatran was cost saving compared to VKAs if annual costs of VKA control exceeded €159 per person, or dabigatran costs were below €2.81 per day.
Dabigatran was cost saving compared to VKAs for the prevention of atrial thromboembolism in patients with non-valvular AF in the Netherlands. This result appeared robust in the sensitivity analysis. Furthermore, volume based reduction of the price in the Netherlands will further increase the monetary benefits of dabigatran.
房颤（AF）给荷兰社会带来了巨大的健康和经济负担。与维生素K拮抗剂（VKA）相比，达比加群在预防房颤患者动脉血栓栓塞方面已被证明具有至少相似的疗效和相似或更好的安全性。
评估达比加群与VKA在荷兰非瓣膜性房颤患者中的成本效益和货币效益。将明确考虑基于价值的定价考量以及关于达比加群的相应谈判。
基础病例经济分析从社会角度进行。使用马尔可夫模型分析健康影响和成本。主要模型输入数据来自RE-LY试验和荷兰观察性数据。进行了单变量、概率敏感性和各种情景分析。
与VKA相比，达比加群具有成本节约效益。在10,000名房颤患者队列中，总共获得了4,552个质量调整生命年（QALY），节省了13,892,288欧元。达比加群的经济价值与避免的VKA控制成本密切相关。值得注意的是，如果VKA控制的年度成本超过每人159欧元，或者达比加群成本低于每天2.81欧元，那么与VKA相比，达比加群具有成本节约效益。
在荷兰，对于非瓣膜性房颤患者预防心房血栓栓塞，达比加群与VKA相比具有成本节约效益。这一结果在敏感性分析中表现稳健。此外，荷兰基于销量的价格下调将进一步增加达比加群的货币效益。
