Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Botto F, Alonso-Coello P, Chan MTV, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120:564–78.

    Article  Google Scholar 

  2. 2.

    Devereaux PJ, Biccard BM, Sigamani A, et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017;317:1642–51.

    CAS  Article  Google Scholar 

  3. 3.

    Levy M, Heels-Ansdell D, Hiralal R, et al. Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a systematic review and meta-analysis. Anesthesiology. 2011;114:796–806.

    CAS  Article  Google Scholar 

  4. 4.

    Devereaux PJ, Duceppe E, Guyatt G, et al. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial. Lancet. 2018;391:2325–34.

    CAS  Article  Google Scholar 

  5. 5.

    Duceppe E, Yusuf S, Tandon V, et al. Design of a randomized placebo-controlled trial to assess dabigatran and omeprazole in patients with myocardial injury after noncardiac surgery (MANAGE). Can J Cardiol. 2018;34:295–302.

    Article  Google Scholar 

  6. 6.

    Lamy A, Tong W, Gao P, et al. The cost of clopidogrel use in atrial fibrillation in the ACTIVE-A trial. Can J Cardiol. 2012;28:95–101.

    Article  Google Scholar 

  7. 7.

    Lamy A, Tong W, Jung H, et al. Cost implications of the use of basal insulin glargine in people with early dysglycemia: the ORIGIN trial. J Diabetes Complicat. 2014;28:553–8.

    CAS  Article  Google Scholar 

  8. 8.

    Lamy A, Tong W, Devereaux PJ, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg. 2014;98:1620–5.

    Article  Google Scholar 

  9. 9.

    Lamy A, Lonn E, Tong W, et al. The cost implication of primary prevention in the HOPE 3 trial. Eur Heart J Qual Care Clin Outcomes. 2019;5(3):266–71.

    Article  Google Scholar 

  10. 10.

    Anon. Formulary search—search results. https://www.formulary.health.gov.on.ca/formulary/results.xhtml?q=dabigatran&type=1. Accessed 23 Mar 2020

  11. 11.

    Briggs A, Gray A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 1998;3:233–45.

    CAS  Article  Google Scholar 

  12. 12.

    Carpenter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000;19:1141–64.

    CAS  Article  Google Scholar 

  13. 13.

    Franchino-Elder J, Gilligan A, Song X, et al. Comparison of healthcare costs among patients with non-valvular atrial fibrillation treated with warfarin who switched to a novel oral anticoagulant. J Pharm Health Serv Res. 2020;11:133–40.

    Article  Google Scholar 

  14. 14.

    Reynolds SL, Ghate SR, Sheer R, et al. Healthcare utilization and costs for patients initiating Dabigatran or Warfarin. Health Qual Life Outcomes. 2017;15(1):128.

    Article  Google Scholar 

  15. 15.

    Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377:1319–30.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Andre Lamy.

Ethics declarations

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.

Availability of Data and Material (Data Transparency)

Not applicable.

Code Availability (Software Application or Custom Code)

Not applicable.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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 (2021). https://doi.org/10.1007/s40256-021-00489-3

Download citation