[Clinical and economic consequences of using dabigatran or rivaroxaban in patients with non-valvular atrial fibrillation]

Abstract

Introduction and objectives: Atrial fibrillation is a supraventricular arrhythmia that increases the risk of ischemic stroke and other thromboembolic events. Recently new treatment options have emerged whose cost-effectiveness relative to conventional therapy (warfarin) is well demonstrated. This study compares the clinical benefits and economic costs associated with the new oral anticoagulants most used in Portugal: dabigatran and rivaroxaban.

Methods: The results of an indirect comparison of the RE-LY and ROCKET AF trials, which enabled differences in the efficacy of dabigatran and rivaroxaban to be determined, were used in a Markov model simulating patient outcomes in terms of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, acute myocardial infarction and intra- and extracranial bleeding.

Results: The use of dabigatran is associated with better clinical results. The reduction in events is reflected in longer survival (8.41 vs. 8.26 years) and more quality-adjusted life years (5.87 vs. 5.74), while the lower daily treatment cost and the reduction in event-related costs lead to a saving of 367 euros per patient from a societal perspective.

Conclusions: The results show that dabigatran is a dominant alternative, i.e., it produces better clinical results at a lower cost. Sensitivity analysis demonstrates that the results are robust even considering the uncertainty inherent in an indirect comparison. It can thus be concluded that in clinical practice in Portugal the use of dabigatran is to be preferred to the use of rivaroxaban.

Keywords: Atrial fibrillation; Cost‐effectiveness; Custo‐efetividade; Dabigatran; Dabigatrano; Fibrilhação auricular; Portugal; Rivaroxaban; Rivaroxabano.