On the cost-effectiveness of dabigatran.

Sobre el coste-efectividad del dabigatrán To the Editor, The introduction of new oral anticoagulants for the prevention of thrombotic events in nonvalvular atrial fibrillation continues to be a subject of debate. One controversial issue is its cost. In a recent issue of the Revista Española de Cardiologı´a, Gonzá lez-Juanatey et al. 1 reported that dabigatran was cost-effective compared with vitamin K antagonists. However, my attention has been drawn to certain aspects that I would like to examine in detail. First, the authors disclose conflicts of interest involving the manufacturer of dabigatran and expressly state that these interests did not influence the results reported in their article. However, Valachis et al. 2 demonstrated that studies in which there are conflicts of interest involving pharmaceutical companies demonstrate that the therapies being examined are cost-effective more often than those in which there are no financial relationships. Cost-effectiveness studies depend on the costs taken into account and on the effectiveness assigned to each arm of the comparison. 3 Gonzá lez-Juanatey et al. estimated the annual costs of vitamin K antagonists anticoagulation therapy with international normalized ratio monitoring in capillary blood to be 378.00 euros with good control and 462.31 euros with poor control. It is surprising that these costs are higher than those reported in the United Kingdom. 4 Even more surprising, however, is that one of the authors fails to recall that, in 2008, he published a study, 5 financed by the Spanish social security system, in which the mean cost of therapy per patient per year was 135.14 euros. Cost analyses can also be carried out by calculating the incremental cost-effectiveness. We calculated the incremental cost-effectiveness of dabigatran vs vitamin K antagonists to assess its cost-effectiveness in our health area. We work with a decentralized system for international normalized ratio determination in capillary blood, with sample collection in 32 units and electronic transfer of the results to the referral center. The dosages are sent back following validation by the hematologist. In our patient population, 69% of the international normalized ratio tests performed are within the therapeutic range. We have 5843 patients receiving anticoagulation therapy, 2320 (40%) due to nonvalvular atrial fibrillation. If we calculate a mean dose of 14 mg per week, 5 the annual cost of the medication is 124 229.50 euros. The cost of international normalized ratio monitoring test is fixed at 2.80 euros per determination, and includes test strips, …