Grant: Project Grant

For more than 50 years, people suffering from atrial fibrillation (the most common type of cardiac arrhythmia) have been treated with a blood thinner called warfarin. Since 2009, a new type of drugs, called direct anticoagulants, is available to treat these patients. In large randomized controlled trials, those drugs (named dabigatran, rivaroxaban, apixaban and edoxaban) have been shown to be as safe and effective as warfarin and subsequent economic evaluations derived from these trials have shown these drugs to be cost-effective compared to warfarin. Such positive results have led multiple drug insurance plans, both in Canada and abroad, to reimburse direct anticoagulants when prescribed by a patient's treating physician. However, even if these economic evaluations were derived from robust large randomized controlled trials, differences between the randomized controlled trial and real-world settings, mainly the potential for less than perfect adherence and difference in patient populations, could alter (either positively or negatively) the real-world value of direct anticoagulants in the Canadian setting. This proposed project specifically aims to examine this possibility as its main objective. In addition, this proposed project also aims to address significant gaps in knowledge regarding the appropriate methods to use when conducting real-world economic evaluations.