If complications of pharmacotherapy are included in the cost effectiveness analysis, the cost effectiveness of dabigatran may be even more favorable.
The lifetime cost of all cause stroke is estimated by the CDC to be $100,000. The rate of stroke per year was 1.57% for Warfarin and 1.01% for 150 mg of dabigatran. Therefore, there is a 0.56% lower rate of stroke per year. In our population of 200 patients, there would be expected to be 1.12 fewer strokes. If each stroke costs $100,000 over the lifetime of the patient then preventing 1.12 fewer cases with dabigatran would save $112,000.
In addition to the small but statistically significant reduction in mortality associated with Dabigatran therapy, there were also numerically (but not statistically significantly) fewer major bleeds (3.4% vs 3.1% per year). The cost of a major bleed is estimated to be $8000 (personal communication, Dr. David Cohen). The cost of treating 200 patients with dabigatran would be reduced slightly by 0.6 bleeds or $4,800 dollars.
There was an increased risk of MI of 0.21% (p=0.048) for dabigatran vs Warfarin (0.74% - 0.53%/year). The cost of a significant q wave MI is $7000 (Source: Dr. David Cohen). Treatment of the 200 patients with dabigatran would yield 0.4 of an MI at an increased cost of $2800.
Treating 200 patients with dabigatran for a year costs an additional $224,600 over Warfarin. Among 200 treated patients, there is a cost reduction of $112,000 due to 1.12 fewer stroke cases with dabigatran. Among these 200 treated patients, there is a cost reduction of $4,800 due to 0.6 fewer major bleeds. There is also a cost increase of $2,800 among these 200 treated patients due to 0.4 MI cases. The total additional cost of dabigatran treatment inclusive of complications in 200 patients is $110,600. The cost per year of life saved assuming 6.75 years of survival could therefore be as low as $16,385.
If society views $50,000 / year of life saved as cost effective, and' if it costs society $110,600 to save that life when the costs of complications are factored in, then' the survival of atrial fibrillation patients must only exceed 2.2 years for the therapy to be cost effective. (Spending $110,600 to save a life of someone who lives 2.2. years equates to $50,000 per year of life saved.) Most 71 year old atrial fibrillation patients survive more than 2.2 years.
What if you factor in the reduction in costly strokes and the reduction in costs due to a reduction in bleeding?
If complications of pharmacotherapy are included in the cost effectiveness analysis, the cost effectiveness of dabigatran may be even more favorable.
The lifetime cost of all cause stroke is estimated by the {{ORGANIZATION}} to be $100,000. The rate of stroke per year was 1.57% for Warfarin and 1.01% for 150 mg of dabigatran. Therefore, there is a 0.56% lower rate of stroke per year. In our population of 200 patients, there would be expected to be 1.12 fewer strokes. If each stroke costs $100,000 over the lifetime of the patient then preventing 1.12 fewer cases with dabigatran would save $112,000.
In addition to the small but statistically significant reduction in mortality associated with Dabigatran therapy, there were also numerically (but not statistically significantly) fewer major bleeds (3.4% vs 3.1% per year). The cost of a major bleed is estimated to be $8000 (personal communication, Dr. {{NAME}}). The cost of treating 200 patients with dabigatran would be reduced slightly by 0.6 bleeds or $4,800 dollars.
There was an increased risk of MI of 0.21% ({{ORGANIZATION}}) for dabigatran vs {{NAME}} (0.74% - 0.53%/year). The cost of a significant q wave MI is $7000 (Source: Dr. {{NAME}}). Treatment of the 200 patients with dabigatran would yield 0.4 of an MI at an increased cost of $2800.
Treating 200 patients with dabigatran for a year costs an additional $224,600 over Warfarin. Among 200 treated patients, there is a cost reduction of $112,000 due to 1.12 fewer stroke cases with dabigatran. Among these 200 treated patients, there is a cost reduction of $4,800 due to 0.6 fewer major bleeds. There is also a cost increase of $2,800 among these 200 treated patients due to 0.4 MI cases. The total additional cost of dabigatran treatment inclusive of complications in 200 patients is $110,600. The cost per year of life saved assuming 6.75 years of survival could therefore be as low as $16,385.
If society views $50,000 / year of life saved as cost effective, and' if it costs society $110,600 to save that life when the costs of complications are factored in, then' the survival of atrial fibrillation patients must only exceed 2.2 years for the therapy to be cost effective. (Spending $110,600 to save a life of someone who lives 2.2. years equates to $50,000 per year of life saved.) Most 71 year old atrial fibrillation patients survive more than 2.2 years.