국내 비판막성 심방세동 환자의 뇌졸중 및 전신색전증 예방을 위한 Dabigatran의 비용-효과성 연구
Cost-Effectiveness of Dabigatran Etexilate versus Warfarin for the Prevention of Stroke and Systemic Embolism in Korea Patients with Non-Valvular Atrial Fibrillation
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Objectives: The aim of this economic evaluation is to estimate the cost-effectiveness of dabigatran etexilate, an orally active thrombin inhibitor that has predictable and stable pharmacokinetics and a wide therapeutic margin, as treatment for the prevention of stroke in non-valvular AF patients who are warfarin eligible according to their stroke risk. Methods: A Markov model estimated the cost-effectiveness of dabigatran etexilate versus warfarin. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on published literature and national statistics. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios. Results: Dabigatran is cost effective vs. warfarin in prescribed setting, which results in an ICER of 18,711,096 KRW/QALY. When compared to warfarin, dabigatran costs 6,574,192 KRW more per patient while increases QALY by 0.21 year per patient. Conclusion: This study demonstrates that dabigatran etexilate is a highly cost-effective alternative, using the ICER threshold (GDP per capita) as Health Insurance Review & Assessment Service(HIRA) recommended, to current care for the prevention of stroke and systemic embolism among Korean non-valvular AF patients.
Abstract
Objectives: The aim of this economic evaluation is to estimate the cost-effectiveness of dabigatran etexilate, an orally active thrombin inhibitor that has predictable and stable pharmacokinetics and a wide therapeutic margin, as treatment for the prevention of stroke in non-valvular AF patients who are warfarin eligible according to their stroke risk. Methods: A Markov model estimated the cost-effectiveness of dabigatran etexilate versus warfarin. A Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events [primary and recurrent ischaemic strokes, systemic embolism, transient ischaemic attack, haemorrhage (intracranial, extracranial, and minor), acute myocardial infarction and death] and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were based on published literature and national statistics. Modelled outcomes over a lifetime horizon included clinical events, quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios. Results: Dabigatran is cost effective vs. warfarin in prescribed setting, which results in an ICER of 18,711,096 KRW/QALY. When compared to warfarin, dabigatran costs 6,574,192 KRW more per patient while increases QALY by 0.21 year per patient. Conclusion: This study demonstrates that dabigatran etexilate is a highly cost-effective alternative, using the ICER threshold (GDP per capita) as Health Insurance Review & Assessment Service(HIRA) recommended, to current care for the prevention of stroke and systemic embolism among Korean non-valvular AF patients.
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