BACKGROUND : Contemporary management of stroke prevention in patients with atrial fibrillation (AF) imposes several challenges, such as drug-drug interactions, drug-food interactions, regular control of international normalised ratio (INR), and hemorrhagic events. This analysis investigates the cost-effectiveness of a new oral anticoagulation (NOAC) drug, which was reported to be a safer and easier drug, as an alternative for warfarin.

METHODS : A Markov decision tree was designed for calculation of cost effective ratio for time span of 1, 2, 5 and 26 years, with the perspective of the Danish health care system as a payer. An utilisation of data reported from RE-LY study was converted into Danish settings. Costs and QALY outcome was based on Danish tariffs and best evidence in literature. One-way analysis and probabilistic sensitivity analysis (PSA) was conducted to evaluate robustness of results obtained.

RESULTS : At base case conditions, the cost effectiveness ratio after the first year was estimated to £ 50969,98 GBP per quality adjusted life year (QALY). After year one, the cost effectiveness ratios showed that dabigatran might be a cost effective alternative, given the set-up of Markov model premises. One-way analysis revealed that key parameters were subjects to uncertainty.

CONCLUSION : This analysis suggests that, with a lifetime perspective, the new anticoagulation drug dabigatran might be a cost effective approach for stroke prophylaxis for patients with diagnosed AF and a CHADS2 score of 1≤, when compared to the standard. However, these results must be taken with caution, as the analysis was based on non-Danish settings and conservative approaches were taken.