Cost-effectiveness analysis of dabigatran and anticoagulation monitoring strategies of Vitamin K antagonist Utilization, expenditure, economics and financing systems
Carles-Lavila, Misericòrdia (Universitat Rovira i Virgili)
Brosa, Max (Oblikue Consulting)
Souto, Juan Carlos (Institut d'Investigació Biomèdica Sant Pau)
Garcia-Alamino, Josep Maria (University of Oxford)
Guyatt, Gordon (McMaster University Medical Centre)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2015
Resum:	Background: Vitamin K antagonists are commonly used for the prevention of thromboembolic events. Patient self-monitoring of vitamin K antagonists has proved superior to usual care. Dabigatran has been shown, relative to warfarin, to reduce thromboembolic events without increasing bleeding. Methods: We constructed a Markov model to compare vitamin K self-monitoring strategies to dabigatran including effectiveness and costs of monitoring and complications (thromboembolism and major bleeding). The model was used to project the incidence of these complications, life years, quality-adjusted life years, and health system costs with anticoagulant treatment throughout life. The analysis was conducted from the health system perspective and from the societal perspective. Results: Low quality evidence suggests that self-monitoring is at least as effective as dabigatran for the outcomes of thrombosis, bleeding and death. Moderate quality evidence that patient self-monitoring is more effective than other forms of monitoring degree of anticoagulation with vitamin K antagonists, reducing the relative risk of thromboembolism by 41 % and death by 34 %. The cost per quality adjusted year gained relative to other warfarin monitoring strategies is well below 30,000 € in the short term, and is a dominant alternative from the fourth year. In comparison with dabigatran, the lower annual cost and its equivalence in terms of effectiveness made self-monitoring the dominant option. These results were confirmed in the probabilistic sensitivity analysis. Conclusions: We have moderate quality evidence that self-monitoring of vitamin K antagonists is a cost-effective alternative compared with hospital and primary care monitoring, and low quality evidence, compared with dabigatran. Our analyses contrast with the available cost analysis of dabigatran and usual care of anticoagulated patients.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atrial fibrillation ; Anticoagulant agents ; Self-care ; Cost an cost-analysis ; Drug monitoring
Publicat a:	BMC health services research, Vol. 15 Núm. 1 (28 2015) , p. 289, ISSN 1472-6963

DOI: 10.1186/s12913-015-0934-9
PMID: 26215871

10 p, 544.4 KB

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