The Cost-Effectiveness Of Dabigatran Etexilate Compared With Warfarin In The Treatment And Secondary Prevention Of Acute Venous Thromboembolism In The Uk

Abstract

Objectives: This economic evaluation aimed to assess the cost-effectiveness of dabigatran compared with warfarin, in the treatment and secondary prevention of acute venous thromboembolism (VTE) comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), in the UK health care setting, based on safety and efficacy data collected during pivotal phase III trials. Methods: A life-time Markov state-transition cohort model was developed around the two primary composite endpoints in the pivotal trials: recurrent VTE and VTE-related death (rVTE), and major or clinically relevant bleeding (MCRB). Intervention-specific probabilities of events within the composite endpoint rVTE (recurrent DVT; recurrent PE) and the composite endpoint MCRB (intracranial haemorrhage; other major bleeds; non-major bleeds) were sourced from the pivotal trials. Beyond the trials follow-up period, the probability of rVTE was sourced from the literature. Longterm consequences of VTE were considered, namely chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome. The perspective on costs was that of the NHS and Public Social Services. Health outcomes were assessed in quality-adjusted life years (QALY). Utility values for health states and events were EQ-5D data collected within the clinical trials, and the published literature. Probabilistic sensitivity analyses (PSA) were undertaken. Results: In patients with index DVT, the estimated incremental cost-effectiveness ratio (ICER) of treatment with dabigatran compared with warfarin was 614 per QALY gained; in patients with index PE, the ICER was 1,285/QALY; in the pooled DVT/PE group, the ICER was 862/QALY. In the treatment followed by secondary prevention analysis, ICER was 8,319/QALY. PSA suggested that the probability of dabigatran being cost-effective at a threshold of 30,000/QALY was 90%, 81% and 94% in acute treatment and 96% in secondary prevention respectively. Conclusions: In a UK setting, dabigatran appears to be a cost-effective option for treatment and secondary prevention of VTE in patients with acute DVT and acute PE compared with warfarin.