Dabigatran was Bioactive compound compared with two warfarin scenarios; one based on clinical trial results and the other reflective of ??real-world prescribing??, in which patient compliance and time in the therapeutic range were substantially reduced. This analysis was based on the rates of clinical outcomes relevant to the population under study and used clinical trial results to accurately estimate the likely risk reduction associated with dabigatran compared with warfarin. In addition to the acquisition costs of both alternatives, it also took into account the costs of anticoagulant monitoring required with warfarin and the costs associated with post-stroke disability, that is, mortality, impact on patients?? quality of life, and the long-term follow-up costs of ischemic stroke and ICH/HS.

[26] The model predicted that the cost of one additional year in perfect health for a patient taking dabigatran would be C$10,440 compared with trial-like warfarin, or C$3,962 compared with ??real-world?? warfarin, both of which were well below the accepted threshold for cost-effectiveness.[26] In terms of budgetary restrictions affecting healthcare systems in the developed world, these estimates represent a highly cost-effective alternative to the current standard of care for the prevention of stroke and systemic embolism. Naturally, the model inputs would be substantially different in an Indian context; the costs associated with drug therapy and the expected clinical outcomes would be different, as would the costs of treating post-stroke disability.

AV-951 Additionally, the assumptions underlying such a model would require various modifications when applied to an Indian setting, to enable a realistic analysis reflective of the local healthcare systems and cost structures. Cost-effectiveness analysis in the Indian context Although HTA is in its infancy in India, there are several recent examples of economic evaluation of healthcare interventions that demonstrate the capabilities of the methodology, and highlight the types of questions it can help to address. For instance, a recent cost-effectiveness analysis assessed a range of interventions aimed at reducing cardiovascular disease and its risk factors in the Indian setting.

[27] Several secondary prevention strategies, Ganetespib supplier such as the use of aspirin, angiotensin-converting-enzyme (ACE) inhibitors, and beta blockers for people with post-acute coronary heart disease and ischemic stroke, could be provided below an arbitrary cost-effectiveness threshold, based on the average income of individuals in India (US$1,000 [Rs.45,000] per disability-adjusted life year [DALY] averted). The DALY is a commonly used economic measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. This study found that treatment of congestive heart failure with ACE inhibitors and beta blockers was also cost-effective, using these criteria.