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

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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.

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Author information

Authors and Affiliations

  1. Population Health Research Institute, McMaster University, DBCVSRI C1-112, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada

    Andre Lamy

  2. CADENCE Research Group, Hamilton Health Sciences, Hamilton, ON, Canada

    Andre Lamy

  3. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Andre Lamy

  4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Andre Lamy

  5. Population Health Research Institute, Hamilton, ON, Canada

    Wesley Tong, Rajibul Mian & Jessica Vincent

  6. Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland

    Wojciech Szczeklik

  7. Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

    Bruce M. Biccard

  8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Emmanuelle Duceppe

  9. Department of Medicine, University of Montreal, Montreal, QC, Canada

    Emmanuelle Duceppe

  10. Department of Cardiovascular Research, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Maria Graza Franzosi

  11. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Sadeesh K. Srinathan

  12. Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark

    Christian S. Meyhoff

  13. Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, ON, Canada

    Joel Parlow

  14. Department of Pharmacology, St John’s Medical College and Research Institute, Bangalore, India

    Denis Xavier

  15. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    P. J. Devereaux

  16. Department of Medicine, McMaster University, Hamilton, ON, Canada

    P. J. Devereaux

  17. Population Health Research Institute, Hamilton, ON, Canada

    P. J. Devereaux

Authors
  1. Andre Lamy
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  2. Wesley Tong
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  3. Rajibul Mian
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  4. Jessica Vincent
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  5. Wojciech Szczeklik
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  6. Bruce M. Biccard
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  7. Emmanuelle Duceppe
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  8. Maria Graza Franzosi
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  9. Sadeesh K. Srinathan
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  10. Christian S. Meyhoff
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  11. Joel Parlow
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  12. Denis Xavier
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  13. P. J. Devereaux
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Corresponding author

Correspondence to Andre Lamy.

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Funding

The MANAGE clinical trial was funded by Boehringer Ingelheim and the Canadian Institutes of Health Research, however no direct funding was allocated for this analysis. The authors had free access to the complete study data and performed all analyses independently of the sponsor.

Conflicts of Interest

Andre Lamy, Wesley Tong, Rajibul Mian, Jessica Vincent, Wojciech Szczeklik, Bruce M. Biccard, Maria Graza Franzosi, Sadeesh K. Srinathan and Joel Parlow report no conflicts of interest. Emmanuelle Duceppe reports grants from Boehringer Ingelheim, Abbott Diagnostics and Roche Diagnostics, as well as lecture fees from Roche Diagnostics. Philip J. Devereaux reports grants from Boehringer Ingelheim and Canadian Health Research Institutes of Canada during the conduct of the study, and grants from Abbott Diagnostics, Boehringer Ingelheim, Covidien, Octopharma, Philips Healthcare, Roche Diagnostics, and Stryker, all outside the submitted work. Denis Xavier reports grants from Cadila Pharmaceuticals, Boehringer Ingelheim, Sanofi-Aventis, Pfizer, Bristol Myers Squibb, and United Health, all outside the submitted work. Christian S. Meyhoff reports direct and indirect institutional research funding from Ferring Pharmaceuticals, Merck Sharp and Dohme Corp., Radiometer, and Boehringer Ingelheim, as well as lecture fees from Radiometer.

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Cite this article

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 22, 83–91 (2022). https://doi.org/10.1007/s40256-021-00489-3

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  • DOI: https://doi.org/10.1007/s40256-021-00489-3

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