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Dabigatran eller warfarin vid elkonvertering i Region Skåne? – En kostnadsminimeringsanalys

Neville, Niklas LU and Norrlid, Hanna LU (2013) NEKH01 20122
Department of Economics
Abstract (Swedish)
Background: Dabigatran has been proved a valid medical substitute to warfarin in stroke preventing treatment of patients with atrial fibrillation. But cost-effectiveness analyses have shown that dabigatran, in comparison to warfarin, is not cost-effective at its current price. However, no existing studies are made in relation to cardio version. The object of this study was thus to evaluate whether it would be cost minimizing to introduce dabigatran with patients preparing for cardio version in Region Skåne.
Methods: Patient data from SUS Malmö was applied in the analysis. For maximum objectiveness patient group homogeneity was created through propensity score matching. Resource consumption was supplied by SUS Malmö as well as derived from... (More)
Background: Dabigatran has been proved a valid medical substitute to warfarin in stroke preventing treatment of patients with atrial fibrillation. But cost-effectiveness analyses have shown that dabigatran, in comparison to warfarin, is not cost-effective at its current price. However, no existing studies are made in relation to cardio version. The object of this study was thus to evaluate whether it would be cost minimizing to introduce dabigatran with patients preparing for cardio version in Region Skåne.
Methods: Patient data from SUS Malmö was applied in the analysis. For maximum objectiveness patient group homogeneity was created through propensity score matching. Resource consumption was supplied by SUS Malmö as well as derived from previous studies. Unit costs were taken from official databases and derived from internal transactions within the health care system of the Skåne region. As the pharmaceuticals are assumed to be medically equivalent this study focus on the costs side and a cost minimizing analysis was performed.
Results: The mean treatment cost was 3273 SEK for warfarin and 3326 SEK for dabigatran. In the main result warfarin was significantly more cost-effective than dabigatran. A subgroup analysis showed that the main result held for female patients, while it was unable to show a significant cost difference for male patients. In a sensitivity analysis the result proved sensitive to an overhead cost quota, time consumption for blood tests and a rough estimate cost.
Conclusion: The results of this study showed that warfarin is more cost effective as an anticoagulant treatment for patients preparing for cardio version than dabigatran.
Discussion: The rough estimate cost refers to, but is not limited to, transportation costs and loss of income for patients corresponding to each blood test occasion. The blood tests are solely included in the warfarin treatment. An additional 15 SEK per blood test would shift the result to be indifferent between the treatments while 140 SEK would cause the result to shift to dabigatran being cost minimizing. An additional 15 SEK is held as an understatement to the real cost and it is thus likely that the treatments from a societal viewpoint are at least equivalently cost effective. Whether 140 SEK is a reasonable estimate must be evaluated further. However, none of this can be proved within the frames of this study due to lack of data. (Less)
Please use this url to cite or link to this publication:
author
Neville, Niklas LU and Norrlid, Hanna LU
supervisor
organization
course
NEKH01 20122
year
type
M2 - Bachelor Degree
subject
keywords
CMA, dabigatran, elkonvertering, hälsoekonomi, hälsoekonomisk utvärdering, Kostnadsminimeringsanalys, Propensity score matching, Region Skåne, SUS Malmö, warfarin
language
Swedish
id
3409528
date added to LUP
2013-02-13 16:30:14
date last changed
2013-02-13 16:30:14
@misc{3409528,
  abstract     = {Background: Dabigatran has been proved a valid medical substitute to warfarin in stroke preventing treatment of patients with atrial fibrillation. But cost-effectiveness analyses have shown that dabigatran, in comparison to warfarin, is not cost-effective at its current price. However, no existing studies are made in relation to cardio version. The object of this study was thus to evaluate whether it would be cost minimizing to introduce dabigatran with patients preparing for cardio version in Region Skåne.
Methods: Patient data from SUS Malmö was applied in the analysis. For maximum objectiveness patient group homogeneity was created through propensity score matching. Resource consumption was supplied by SUS Malmö as well as derived from previous studies. Unit costs were taken from official databases and derived from internal transactions within the health care system of the Skåne region. As the pharmaceuticals are assumed to be medically equivalent this study focus on the costs side and a cost minimizing analysis was performed. 
Results: The mean treatment cost was 3273 SEK for warfarin and 3326 SEK for dabigatran. In the main result warfarin was significantly more cost-effective than dabigatran. A subgroup analysis showed that the main result held for female patients, while it was unable to show a significant cost difference for male patients. In a sensitivity analysis the result proved sensitive to an overhead cost quota, time consumption for blood tests and a rough estimate cost. 
Conclusion: The results of this study showed that warfarin is more cost effective as an anticoagulant treatment for patients preparing for cardio version than dabigatran. 
Discussion: The rough estimate cost refers to, but is not limited to, transportation costs and loss of income for patients corresponding to each blood test occasion. The blood tests are solely included in the warfarin treatment. An additional 15 SEK per blood test would shift the result to be indifferent between the treatments while 140 SEK would cause the result to shift to dabigatran being cost minimizing. An additional 15 SEK is held as an understatement to the real cost and it is thus likely that the treatments from a societal viewpoint are at least equivalently cost effective. Whether 140 SEK is a reasonable estimate must be evaluated further. However, none of this can be proved within the frames of this study due to lack of data.},
  author       = {Neville, Niklas and Norrlid, Hanna},
  keyword      = {CMA,dabigatran,elkonvertering,hälsoekonomi,hälsoekonomisk utvärdering,Kostnadsminimeringsanalys,Propensity score matching,Region Skåne,SUS Malmö,warfarin},
  language     = {swe},
  note         = {Student Paper},
  title        = {Dabigatran eller warfarin vid elkonvertering i Region Skåne? – En kostnadsminimeringsanalys},
  year         = {2013},
}