An Economic Evaluation Of Anticoagulant Strategies For Stroke Prevention In Atrial Fibrillation In China

Objective:To evaluate the potential cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism among patients with AF as compared to warfarin as a first-line therapy, from the payer perspective in China.Methods:An individual level simulation model was developed to simulate the clinical events and outcomes under different treatment pathways over a patient’s remaining lifetime. Input data were derived from the published literatures and expert inputs. One way sensitivity analysis was used to test the stability of the results and identify key variables.Results:Comparing to warfarin first-line use among patients eligible for anticoagulants, dabigatran was associated with0.63fewer ischemic stroke,0.18fewer hemorrhagic stroke,0.32fewer intracranial hemorrhage,0.10fewer systemic embolism,0.56fewer transient ischemic attack,0.75more extra-cranial hemorrhage and0.24more acute myocardial infarction, per100patient-year. Total discounted lifetime costs for warfarin and dabigatran were￥35,732.48and￥109,305.21, total QALYs were6.98and7.18, resulting an ICER of￥375,291.35per QALY gained. The result was sensitive to dabigatran cost, INR control assumptions, cycle length and time horizon.Conclusions:Warfarin was considered to be cost-effective at the WTP of￥115,261/QALY.