Table 36Results of Stratified Analysis by CHADS2 Score

CostQALYsIncremental Cost Per QALY Gained (ICER)
vs.
Warfarin
Sequential ICER
CHADS2 SCORE < 2
Warfarin$16,0467.004
Dabigatran 150 mg$20,1127.163$25,570$25,570
Dabigatran 110 mg$21,9477.050$129,575Dominated by dabigatran 150 mg and apixaban
Apixaban$21,0527.117$44,289Dominated by dabigatran 150 mg
CHADS2 SCORE = 2
Warfarin$15,3176.084
Dabigatran 150 mg$18,6946.202$28,407 1$28,407
Apixaban$18,9166.207$29,156$48,588
Dabigatran 110 mg$19,5896.152$62,432Dominated by dabigatran 150 mg, rivaroxaban, and apixaban
Rivaroxaban$18,6156.154$46,575Extendedly dominated by apixaban and warfarin, and dabigatran 150 mg and warfarin
CHADS2 SCORE > 2 (no previous stroke)
Warfarin$23,4476.548
Dabigatran 150 mg$25,1836.730$9,559$9,559
Apixaban$25,5876.739$11,225$44,687
Dabigatran 110 mg$26,3946.661$26,090Dominated by rivaroxaban, dabigatran 150 mg, and apixaban
Rivaroxaban25718.536.667$19,035Dominated by dabigatran 150 mg and apixaban
CHADS2 SCORE > 2 (with previous minor stroke)
Warfarin$73,5374.448
Dabigatran 150 mg$75,3924.635$9,944$9,944
Apixaban$76,1714.612$16,108Dominated by dabigatran 150 mg
Dabigatran 110 mg$77,1954.534$42,592Dominated by rivaroxaban, dabigatran 150 mg, and apixaban
Rivaroxaban$75,6104.569$17,121Dominated by dabigatran 150 mg, and extendedly dominated by apixaban and warfarin
CHADS2 SCORE > 2 (with previous major stroke)
Warfarin$134,9432.153
Dabigatran 150 mg$140,5662.200$121,905$121,905
Apixaban$140,7342.199$126,252Dominated by dabigatran 150 mg
Dabigatran 110 mg$140,2702.177$222,599Dominated by rivaroxaban, and dabigatran 150 mg extendedly dominated by apixaban and warfarin
Rivaroxaban$139,4342.184$145,146Dominated by dabigatran 150 mg, and extendedly dominated by apixaban and warfarin

ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life-year; vs. = versus.

Note: Dominated = more costly and less QALYs; extended dominance = the combination of two other alternatives dominates the treatment. Risk reductions relative to warfarin are specific to CHADS2 score for stroke, and are for the complete RE-LY trial population for all other events. Warfarin event rates are specific to CHADS2 for stroke, major bleed, ICH, and non-vascular deaths, and for the complete RE-LY trial population for all other events. For rivaroxaban, there were no available data for the risk reduction for stroke with CHADS2 score <2.

From: 4, ECONOMIC REVIEW

Cover of Safety, Effectiveness, and Cost-Effectiveness of New Oral Anticoagulants Compared with Warfarin in Preventing Stroke and Other Cardiovascular Events in Patients with Atrial Fibrillation
Safety, Effectiveness, and Cost-Effectiveness of New Oral Anticoagulants Compared with Warfarin in Preventing Stroke and Other Cardiovascular Events in Patients with Atrial Fibrillation [Internet].
Wells G, Coyle D, Cameron C, et al.
Copyright © 2012 Canadian Collaborative for Drug Safety, Effectiveness and Network Meta-Analysis.

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