Chondroitin before age 80, and in 82% of simulations versus warfarin when patients initiated treatment at age 80 or above. Figure 3 shows the costeffectiveness acceptability curves for each scenario analysed. These curves show the fraction of simulations that resulted in cost effectiveness below a specific willingness to pay threshold. For example, the probability that dabigatran is cost effective for patients under the age of 80 years at the commonly cited WTP threshold of 0 000/QALY gained was 98% against warfarin, and 100% against aspirin and no treatment. In patients initiating treatment at age 80, the probability of costeffectiveness versus nattokinase warfarin was 63% at the same WTP threshold. DISCUSSION This economic evaluation estimated the cost effectiveness of dabigatran compared with warfarin, aspirin and no treatment for prevention of stroke and SE in patients with AF. The modelled evaluation estimated that use of dabigatran was likely to be cost effective in all comparisons and analyses conducted.
That is, for all comparisons, the ICERs for dabigatran were well below the benchmark WTP threshold of 0 000/QALY gained. The low ICERs for patients research chemicals library receiving dabigatran reflect the significant reduction in catastrophic events and the substantial savings that were achieved through the reduction in long term disability as a consequence. Cost effectiveness for dabigatran treatment versus warfarin was demonstrated for patients initiating treatment at age 80 years despitesimilar clinical benefit for warfarin and dabigatran treatment in terms of IS. In this population, which receives only the 110 mg twice daily dose of dabigatran, cost effectiveness is driven specifically by the reduction in ICH and HS and associated sunitinib reductions in mortality and disability. Deterministic and probabilistic sensitivity analyses showed that these ICERs were robust to uncertainty and variability in the model parameters. It was demonstrated that average population warfarin control would need to be raised to levels not observed in routine practice for 0 000/QALY gained to be exceeded. These consistent costeffectiveness results are in line with the improved efficacy and safety outcomes demonstrated in RE LY.
These results are also consistent with analyses in the US29 30 and Canadian settings,16 though, using a higher US dabigatran price, Shah and Gage found low risk subpopulations in which dabigatran was less cost effective. None of the prior analyses presented cost effectiveness results versus remaining untreated. LIMITATIONS As with any economic model, results rest on important assumptions. The key modelling assumption is that of continued benefit with ongoing anticoagulation treatment. The decision to anticoagulate patients with AF should be life long, therefore, it was appropriate to model costs and outcomes over the lifetime without arbitrarily truncating the model time horizon, especially as post stroke annum disability continues over patientsremaining life. To be conservative, the model included clinical event risks based on the intent to treat population, while also explicitly including discontinuation of treatment. A major driver in the model is cost of long term disability management. As systematic follow up of patients in RE LY suffering an event was limited to 3e6 months.