Abstract WMP98: Economic Impact Of Dabigatran For Prevention Of Stroke In Patients With Atrial Fibrillation In Colombia

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INTRODUCTION: Dabigatran is a novel oral anticoagulant considered as an alternative to warfarin in patients with non-valvular Atrial Fibrillation (AF) to prevent Stroke. Hypothesis: dabigatran compared to warfarin for stroke prevention in AF is a good investment for the health care system in Colombia. Methods: We developed a Markov model to represent the health states of AF and its complications: 6 health states (disabling and non-disabling stroke, myocardial infarction, pulmonary embolism and death) and 2 transitional states (major and minor hemorrhage). Probabilities were derived from clinical trials; resource use was estimated from the guidelines of the Colombian Society of Cardiology and validated to adjust to usual practice. Direct medical costs were extracted from public and private insurers and hospitals, and indirect costs (e.g. wages lost, transportation costs, etc.) were obtained from the most recent National Health Survey. Utilities were obtained from a systematic literature review. Two separate analysis, payer and societal perspective, were performed in a 20-year horizon. Multivariate sensitivity analysis was also performed and results were discounted at 3% annually. Results: After 20 years of follow up, cumulative discounted direct medical costs per patient accounted for USD$70,500 for warfarin and $78,840 and $79,860 for 150mg and 110mg of dabigatran, respectively. When taking into account indirect costs, warfarin increased their costs by 13% while dabigatran costs were increased by 7%. Estimated life years (LY) for Dabigatran were higher (9.4 and 9.3 for 150mg and 110mg) as well as the QALYs (8.5, 8.4) than for warfarin 9.1 LY and 8.1 QALYs. The calculated ICER was $23,760 and $34,690 per additional QALY gained with dabigatran 150mg and 110 mg from the payer perspective and $19,380 and $28,730 from the societal perspective. The budget impact of including coverage for dabigatran would not surpass 3% of the current unit of payment per capita. CONCLUSIONS: In Colombia, coverage for dabigatran for the management of non-complicated AF could increase LY and QALYs at a modest financial impact.