【文献名】
Shimoli V. Shah and Brian F. Gage. Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation. (Circulation. 2011;123:2562-2570.)
【要約】
＜Background＞
Recent studies have investigated alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation (AF), but whether these alternatives are cost-effective is unknown.
＜Methods and Results＞
On the basis of the results from Randomized Evaluation of Long Term Anticoagulation Therapy
(RE-LY) and other trials, we developed a decision-analysis model to compare the cost and quality-adjusted survival of various antithrombotic therapies. We ran our Markov model in a hypothetical cohort of 70-year-old patients with AF using a cost-effectiveness threshold of $50 000/quality-adjusted life-year. We estimated the cost of dabigatran as US $9 a day. For a patient with an average risk of major hemorrhage (3%/y), the most cost-effective therapy depended on stroke risk. For patients with the lowest stroke rate (CHADS 2 stroke score of 0), only aspirin was cost-effective. For patients with a moderate stroke rate (CHADS 2 score of 1 or 2), warfarin was cost-effective unless the risk of hemorrhage was high or quality of international normalized ratio control was poor (time in the therapeutic range 57.1%). For patients with a high stroke risk (CHADS 2 stroke score 3), dabigatran 150 mg (twice daily) was cost-effective unless international normalized ratio control was excellent (time in the therapeutic range 72.6%). Neither dabigatran 110 mg nor dual therapy (aspirin and clopidogrel) was cost-effective.
＜Conclusions＞
Dabigatran 150 mg (twice daily) was cost-effective in AF populations at high risk of hemorrhage or high risk of stroke unless international normalized ratio control with warfarin was excellent. Warfarin was cost-effective in moderate-risk AF populations unless international normalized ratio control was poor.
【開催日】
2011年7月26日