Stop the clots, but at what cost? Pharmacoeconomics of dabigatran etexilate for the prevention of stroke in subjects with atrial fibrillation: a systematic literature review

Abstract

Dabigatran etexilate is a newly approved agent for prophylaxis of stroke in atrial fibrillation. Through narrative review, the authors assess evidence of the efficacy of dabigatran in stroke prevention, focusing on the multicenter, randomized trial RE-LY. The authors complement this with a review of the clinical efficacy of standard treatments (antiplatelet and warfarin). Finally, the authors present a systematic review of published studies describing the economics of dabigatran. Our systematic search gave six economic reviews from a variety of healthcare systems (the USA, Canada and the UK) and utilizing different economic models. Analyses suggest economic benefit of high- or sequential-dose dabigatran, particularly when stroke risk is high; intracerebral hemorrhage risk is high or warfarin control is poor. However, questions remain around dabigatran tolerability, compliance and possible unexpected adverse events.

Keywords::

• anticoagulants
• cost–efficacy
• dabigatran
• economics
• stroke
• warfarin

Financial & competing interests disclosure

TJ Quinn has received travel assistance, speakers’ honoraria or research support from AstraZeneca, Bristol Meyers Squibb, Boehringer Ingelheim, Merk and Pfizer. J Dawson has received travel assistance, speakers’ honoraria or research support from AstraZeneca, Boehringer Ingelheim, Bristol Meyers Squibb, Merk and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.