Abstract
To assess the cost-effectiveness of dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in Chinese patients with non-valvular atrial fibrillation (NVAF). A Markov model was constructed to estimate the cost-effectiveness of dabigatran versus rivaroxaban from China healthcare system’s perspective. Clinical events were modelled for a lifetime horizon, based on clinical efficacy data from indirect treatment comparison using the RE-LY and other clinical trials. The weighted averages of the most recent prices of two drugs were used as drug acquisition costs. Other costs were collected using a survey from a panel of local experts. Utility inputs were obtained from a published literature. Model outcomes included clinical events, life years (LYs), quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs). Future costs and QALYs were discounted at 3.5%. Net monetary benefit (NMB) analysis with a recommended willingness-to-pay threshold at ¥161,940 was conducted. Sensitivity analyses, including scenario analyses and probabilistic sensitivity analysis (PSA), were conducted to assess the robustness of the economic modelling. Over a lifetime, patients treated with dabigatran experienced fewer ischemic stroke (2.14 dabigatran vs. 2.61 rivaroxaban) and fewer intracranial haemorrhage (0.48 vs. 0.94) per 100 patient-years. In the base-case analysis, dabigatran had an incremental cost of ¥28,128 but with higher LYs (10.38 vs. 10.14) and QALYs (7.95 vs. 7.70). The resulting ICER of ¥112,910 per QALY gained and NMB of ¥12,214 versus rivaroxaban showed that dabigatran was a cost-effective alternative to rivaroxaban. Extensive sensitivity analyses indicated that results were robust over a wide range of inputs. The PSA indicated dabigatran was cost-effective in 84.2% of the 10,000 Monte-Carlo simulations compared with rivaroxaban. Dabigatran reduced the occurrence of clinical events and increased QALYs compared with rivaroxaban. Dabigatran is cost-effective compared to rivaroxaban for the prevention of stroke and systemic embolism among NVAF patients in China.
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