Ximelagatran cost effectiveness for stroke prevention in atrial fibrillation

Publication Type:
Journal Article
Journal of Pharmacy Practice and Research, 2005, 35 (4), pp. 279 - 283
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Background: The benefit of warfarin for stroke prevention in non-valvular atrial fibrillation has been demonstrated in various clinical trials. Warfarin has a narrow therapeutic window and carries a significant risk of bleeding. Ximelagatran is a new oral antithrombotic with predictable plasma concentrations and excellent bioavailability. Aim: To compare the costs and benefits of ximelagatran to that of warfarin and aspirin. Method: In a preliminary cost-effectiveness analysis, the costs and clinical consequences of warfarin, aspirin and ximelagatran were compared. The principal outcome was measured in the form of an incremental cost-effectiveness ratio. A decision analysis model was constructed to map the expected outcomes of three treatment alternatives. Sensitivity analysis tested the robustness of the data. Results: Warfarin appeared to be most cost effective in this clinical setting. The incremental cost-effectiveness ratio indicated that the use of ximelagatran in preference to warfarin would cost an additional $272 000/patient/year. Likewise the use of ximelagatran in preference to aspirin would cost an additional $13 000/patient/year. Conclusion: Ximelagatran appears to be cost effective in a small group of high-risk patients. This may have implications for the development of treatment guidelines in this clinical setting.
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