David W. Hutton

Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation

BACKGROUND Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin. OBJECTIVE To estimate the quality-adjusted survival, costs, and cost-effectiveness of dabigatran compared with adjusted-dose warfarin for preventing ischemic stroke in patients 65 years or older with nonvalvular AF. DESIGN Markov decision model. DATA SOURCES The RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial and other published studies of anticoagulation. The cost of dabigatran was estimated on the basis of pricing in the United Kingdom. TARGET POPULATION Patients aged 65 years or older with nonvalvular AF and risk factors for stroke (CHADS₂ score ≥1 or equivalent) and no contraindications to anticoagulation. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION Warfarin anticoagulation (target international normalized ratio, 2.0 to 3.0); dabigatran, 110 mg twice daily (low dose); and dabigatran, 150 mg twice daily (high dose). OUTCOME MEASURES Quality-adjusted life-years (QALYs), costs (in 2008 U.S. dollars), and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS The quality-adjusted life expectancy was 10.28 QALYs with warfarin, 10.70 QALYs with low-dose dabigatran, and 10.84 QALYs with high-dose dabigatran. Total costs were

Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B.

143 193 for warfarin,

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164 576 for low-dose dabigatran, and

Cost-Effectiveness Analysis Evaluating Fidaxomicin versus Oral Vancomycin for the Treatment of Clostridium difficile Infection in the United States

168 398 for high-dose dabigatran. The incremental cost-effectiveness ratios compared with warfarin were

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51 229 per QALY for low-dose dabigatran and

Cost-Effectiveness of Bevacizumab and Ranibizumab for Newly Diagnosed Neovascular Macular Degeneration

45 372 per QALY for high-dose dabigatran. RESULTS OF SENSITIVITY ANALYSIS The model was sensitive to the cost of dabigatran but was relatively insensitive to other model inputs. The incremental cost-effectiveness ratio increased to

Cost‐effectiveness of nationwide hepatitis B catch‐up vaccination among children and adolescents in China

50 000 per QALY at a cost of

Switching To Less Expensive Blindness Drug Could Save Medicare Part B

13.70 per day for high-dose dabigatran but remained less than

18 Billion Over A Ten-Year Period

85 000 per QALY over the full range of model inputs evaluated. The cost-effectiveness of high-dose dabigatran improved with increasing risk for stroke and intracranial hemorrhage. LIMITATION Event rates were largely derived from a single randomized clinical trial and extrapolated to a 35-year time frame from clinical trials with approximately 2-year follow-up. CONCLUSION In patients aged 65 years or older with nonvalvular AF at increased risk for stroke (CHADS₂ score ≥1 or equivalent), dabigatran may be a cost-effective alternative to warfarin depending on pricing in the United States. PRIMARY FUNDING SOURCE American Heart Association and Veterans Affairs Health Services Research & Development Service.

Cost-Effectiveness of Various Interventions for Newly Diagnosed Diabetic Macular Edema

Context About 10% of Asian and Pacific Islander adults in the United States are chronically infected with hepatitis B virus (HBV). Many are unaware of their infection and do not receive antiviral treatment. Contribution This analysis assesses the incremental cost-effectiveness of alternative strategies for voluntary screening for HBV in Asian and Pacific Islander adults. Compared with voluntary screening only, a strategy of screening and then treating infected persons and a strategy of screening and treating infected persons and ring vaccinating close contacts were cost-effective (about