Objectives: To estimate the cost-effectiveness of dabigatran etexilate (dabigatran) for the secondary prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) from the perspective of the UK National Health Service.
Methods: A Markov model was developed to estimate costs and outcomes over the lifetime of a cohort of patients receiving either dabigatran (150mg given orally, twice daily) or placebo for 6 months after having completed 6 to 18 months of anticoagulation treatment for a DVT or PE. Modelled events included recurrent DVT and PE, major bleeding (including long-term disability from intracranial haemorrhage), clinically relevant non-major bleeding, myocardial infarction, unstable angina, pulmonary hypertension, severe postthrombotic syndrome, and death. Efficacy and safety parameters were based on the RE-SONATE study; the period of follow-up was 6 months with an extension to 18 months. Probabilities of recurrent DVT and PE after trial follow-up were based on a prospective cohort study of 1,626 patients followedup for a median of 50 months and were assumed to be equivalent in both treatment groups. Utility estimates were based on EQ-5D data collected in dabigatran trials and published literature. The mean duration of therapy was based on the RE-SONATE study; other costs were based on NHS Reference Costs and published literature. Costs and outcomes were discounted at 3.5% per annum. Univariate and probabilistic sensitivity analyses were performed.
Results: In the base-case analysis, mean total costs for dabigatran and placebo patients were £7,147 and £7,520 respectively; mean QALYs were 13.089 and 13.070 respectively. Dabigatran was dominant; the probability of cost-effectiveness at a willingness-to-pay threshold of £20,000 per QALY was 63%. In univariate sensitivity analysis, dabigatran was dominant in all analyses.
Conclusions: This analysis suggests that dabigatran is likely to be costsaving compared to placebo for the secondary prevention of DVT and PE in the UK.
