Letter to the editor On the Cost-effectiveness of Dabigatran. Response

To the Editor,

We would like to respond to the considerations of the author of the letter concerning our article.¹

With respect to the doubts about the results obtained in our study and the independence of the authors, we wish to point out that different agencies for the assessment of health technologies, such as the National Institute for Health and Clinical Excellence, as well as publications in countries in which high quality anticoagulation management is achieved with vitamin K antagonists, obtain results similar to ours. This fact is of great importance in the inclusion of dabigatran in different clinical practice guidelines and its addition to the range of health care services provided in a number of countries in Western Europe.

The cost quoted for international normalized ratio monitoring was obtained from a study performed by the Institut Català de la Salut,² and a sensitivity analysis was carried out in which modifying this cost produced no changes in the results.

The cost evaluation presented by the author is incomplete³; among other items, he does not consider the total cost of the treatments, since the cost of events and of the resources consumed (stroke, bleeding, rehabilitation, and follow-up, in cases of dependence) are not included. An approach of this type would only be applicable when dealing with treatments having the same efficacy and safety, and cost minimization analysis should be employed.

The author considers that cost-effectiveness studies should be carried out by independent organisms, rather than by pharmaceutical companies. The key in this issue is that the economic evaluation of health technologies should be performed, in a meticulous and standardized way, by all the agents involved, including the pharmaceutical companies. This is a complex process that is undergoing continuous development, under the leadership of relevant authors and scientific organizations and the International Society for Pharmacoeconomics and Outcomes Research, and reflected in the guidelines of the international evaluation agencies utilized as referents by national health systems and pharmaceutical companies in general.

We would like to conclude by saying that a number of the assertions of the author are based on subjective impressions, are compromised by an incomplete economic evaluation, and have not been checked against results available in other countries of Western Europe, which are very similar to ours in Spain.

Conflicts of interest

Nuria González-Rojas is an employee of Boehringer Ingelheim.

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