Cost effective medications for preventing stroke in atrial fibrillation

January 01, 0001

Cost effective medications for preventing stroke in atrial fibrillation

Stroke is perhaps the most dreaded sequelae of atrial fibrillation (AF). A number of medication have been shown to be of benefit clinically for preventing stroke in AF, but the cost effectiveness of these therapies is not always clear. These US researchers used the results from various trials, including the Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) to create a decision-analysis model to compare the cost-effectiveness of various anti-thrombotic agents.

The researchers found: "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 (CHADS2 stroke score of 0), only aspirin was cost-effective. For patients with a moderate stroke rate (CHADS2 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 (CHADS2 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."

The researchers concluded: "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."

Aspirin, warfarin, and dabigatran were all found to be cost effective in specific risk groups and depending on how well the INR was controlled

For the full abstract, click here.

Circulation 123(22):2562-2570, 7 June 2011 © 2011 American Heart Association, Inc.
Cost-Effectiveness of Dabigatran for Stroke Prophylaxis in Atrial Fibrillation. Shimoli V. Shah, Brian F. Gage. Correspondence to Brian F. Gage: [email protected]

Category: K. Circulatory. Keywords: atrial fibrillation, stroke, aspirin, warfarin, dabigatran, cost- effectiveness model, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 21 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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