How country-specific should a country-specific cost-effectiveness analysis be?

Abstract

This editorial refers to ‘Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden’†, by T. Davidson et al. , on page 177 and ‘Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: results from the PLATO study’‡, by E. Nikolic et al. , on page 220 Two recent cost-effectiveness analyses published in the European Heart Journal add to a growing evidence base regarding the costs and health outcomes associated with dabigatran vs. warfarin for patients with atrial fibrillation1 and ticagrelor vs. clopidogrel for patients with acute coronary syndromes.2 Conducted from the perspective of the Swedish healthcare system, both analyses are trial-based economic evaluations augmented with decision models to extrapolate short-term trial outcomes to longer term estimates of costs and quality-adjusted survival. The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) provided primary data for the cost-effectiveness analysis of dabigatran vs. warfarin.3 The Platelet Inhibition and Patient Outcomes (PLATO) trial provided primary data for the cost-effectiveness analysis of ticagrelor vs. clopidogrel.4 Both trials were large, multinational, randomized controlled studies. RE-LY enrolled 18 113 patients in 44 countries, and PLATO enrolled 18 624 patients in 43 countries. In both analyses, the analysts relied on clinical data that were pooled across all countries represented in the trial. To inform decision making in Sweden, …