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Lamy A, Tong W, Mian R, et al. The Cost Implications of Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery. Am J Cardiovasc Drugs. 2021;22(1):83-91doi: 10.1007/s40256-021-00489-3.
Lamy, A., Tong, W., Mian, R., Vincent, J., Szczeklik, W., Biccard, B. M., Duceppe, E., Franzosi, M. G., Srinathan, S. K., Meyhoff, C. S., Parlow, J., Xavier, D., & Devereaux, P. J. (2022). The Cost Implications of Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery. American journal of cardiovascular drugs : drugs, devices, and other interventions, 22(1), 83-91. https://doi.org/10.1007/s40256-021-00489-3
Lamy, Andre, et al. "The Cost Implications of Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery." American journal of cardiovascular drugs : drugs, devices, and other interventions vol. 22,1 (2022): 83-91. doi: https://doi.org/10.1007/s40256-021-00489-3
Lamy A, Tong W, Mian R, Vincent J, Szczeklik W, Biccard BM, Duceppe E, Franzosi MG, Srinathan SK, Meyhoff CS, Parlow J, Xavier D, Devereaux PJ. The Cost Implications of Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery. Am J Cardiovasc Drugs. 2022 Jan;22(1):83-91. doi: 10.1007/s40256-021-00489-3. Epub 2021 Jul 26. PMID: 34308517.
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Am J Cardiovasc Drugs. 2022 Jan;22(1):83-91. doi: 10.1007/s40256-021-00489-3. Epub 2021 Jul 26.

The Cost Implications of Dabigatran in Patients with Myocardial Injury After Non-Cardiac Surgery.

American journal of cardiovascular drugs : drugs, devices, and other interventions

Andre Lamy, Wesley Tong, Rajibul Mian, Jessica Vincent, Wojciech Szczeklik, Bruce M Biccard, Emmanuelle Duceppe, Maria Graza Franzosi, Sadeesh K Srinathan, Christian S Meyhoff, Joel Parlow, Denis Xavier, P J Devereaux

Affiliations

  1. Population Health Research Institute, McMaster University, DBCVSRI C1-112, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada. [email protected].
  2. CADENCE Research Group, Hamilton Health Sciences, Hamilton, ON, Canada. [email protected].
  3. Department of Surgery, McMaster University, Hamilton, ON, Canada. [email protected].
  4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. [email protected].
  5. Population Health Research Institute, Hamilton, ON, Canada.
  6. Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  7. Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
  8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  9. Department of Medicine, University of Montreal, Montreal, QC, Canada.
  10. Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
  11. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
  12. Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
  13. Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
  14. Department of Pharmacology, St John's Medical College and Research Institute, Bangalore, India.
  15. Department of Medicine, McMaster University, Hamilton, ON, Canada.

PMID: 34308517 DOI: 10.1007/s40256-021-00489-3

Abstract

BACKGROUND: The Management of Myocardial Injury after Non-Cardiac Surgery (MANAGE) trial demonstrated that dabigatran 110 mg twice daily was more effective than placebo in preventing the primary composite outcome of vascular mortality, non-fatal myocardial infarction, non-hemorrhagic stroke, peripheral arterial thrombosis, amputation and symptomatic venous thromboembolism in patients with myocardial injury after non-cardiac surgery (MINS). The cost implications of dabigatran for this population are unknown but are important given the significant clinical implications.

METHODS: Hospitalized events, procedures, and study and non-study medications were documented. We applied Canadian unit costs to healthcare resources consumed for all patients in the trial, and calculated the average cost per patient in Canadian dollars for the duration of the study (median follow-up of 16 months). A sensitivity analysis was performed using only Canadian patients, and subgroup analyses were also conducted.

RESULTS: The total study cost for the dabigatran group was $9985 per patient, compared with $10,082 for placebo, a difference of - $97 (95% confidence interval [CI] - $2128 to $3672). Savings arising from fewer clinical events and procedures in the dabigatran 110 mg twice-daily group were enough to offset the cost of the study drug. In Canadian patients, the difference was $250 (95% CI -$2848 to $4840). Both differences were considered cost neutral. Dabigatran 110 mg twice daily was cost saving or cost neutral in many subgroups that were considered.

CONCLUSION: Dabigatran 110 mg twice daily was cost neutral for patients in the MANAGE trial. Our cost findings support the use of dabigatran 110 mg twice daily in patients with MINS.

TRIAL REGISTRATION: ClinicalTrials.gov identifier number NCT01661101.

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

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