Cost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile

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dc.article.number34
dc.catalogadorpva
dc.contributor.authorAbbot, Tomás
dc.contributor.authorArmijo Escalona, Nicolás Andrés
dc.contributor.authorRojas Orellana, Luis
dc.contributor.authorGiglio Jiménez, Andrés Enrique
dc.contributor.authorBalmaceda, Carlos
dc.contributor.authorEspinoza Sepúlveda, Manuel Antonio
dc.date.accessioned2025-07-29T15:29:29Z
dc.date.available2025-07-29T15:29:29Z
dc.date.issued2025
dc.date.updated2025-07-28T12:13:34Z
dc.description.abstractBackground Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation. Aims To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective. Methods A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis. Results Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean cost-effectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context. Conclusion Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.
dc.fechaingreso.objetodigital2025-07-28
dc.format.extent13 páginas
dc.fuente.origenBiomed Central
dc.identifier.citationCost Effectiveness and Resource Allocation. 2025 Jul 07;23(1):34
dc.identifier.doi10.1186/s12962-025-00642-8
dc.identifier.issn1478-7547
dc.identifier.urihttps://doi.org/10.1186/s12962-025-00642-8
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/105052
dc.information.autorucEscuela de Medicina; Abbot, Tomás; S/I; 203717
dc.information.autorucEscuela de Medicina; Armijo Escalona, Nicolás Andrés; S/I; 233953
dc.information.autorucEscuela de Medicina; Rojas Orellana, Luis; 0000-0002-0234-5876; 135613
dc.information.autorucEscuela de Medicina; Giglio Jiménez, Andrés Enrique; S/I; 179211
dc.information.autorucEscuela de Medicina; Balmaceda, Carlos; 0000-0002-8381-2439; 169851
dc.information.autorucEscuela de Medicina; Espinoza Sepúlveda, Manuel Antonio; 0000-0001-9564-9512; 10720
dc.issue.numero1
dc.language.isoen
dc.nota.accesocontenido completo
dc.publisherSpringer Nature
dc.revistaCost Effectiveness and Resource Allocation
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectCost-effectiveness
dc.subjectAtrial fibrillation
dc.subjectDabigatran
dc.subjectThromboembolic events
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleCost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile
dc.typeartículo
dc.volumen23
sipa.codpersvinculados203717
sipa.codpersvinculados233953
sipa.codpersvinculados135613
sipa.codpersvinculados179211
sipa.codpersvinculados169851
sipa.codpersvinculados10720
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