Dabigatran - a continuing exemplar case history demonstrating the need for comprehensive models to optimize the utilization of new drugs

Godman, Brian and Malmström, Rickard E. and Diogene, Eduardo and Jayathissa, Sisira and McTaggart, Stuart and Cars, Thomas and Alvarez-Madrazo, Samantha and Baumgärtel, Christoph and Brzezinska, Anna and Bucsics, Anna and Campbell, Stephen and Eriksson, Irene and Finlayson, Alexander and Fürst, Jurij and Garuoliene, Kristina and Gutiérrez-Ibarluzea, Iñaki and Hviding, Krystyna and Herholz, Harald and Joppi, Roberta and Kalaba, Marija and Laius, Ott and Malinowska, Kamila and Pedersen, Hanne B. and Markovic-Pekovic, Vanda and Piessnegger, Jutta and Selke, Gisbert and Sermet, Catherine and Spillane, Susan and Tomek, Dominik and Vončina, Luka and Vlahović-Palčevski, Vera and Wale, Janet and Wladysiuk, Magdalena and van Woerkom, Menno and Zara, Corinne and Gustafsson, Lars L. (2014) Dabigatran - a continuing exemplar case history demonstrating the need for comprehensive models to optimize the utilization of new drugs. Frontiers in Pharmacology, 5. 109. ISSN 1663-9812 (https://doi.org/10.3389/fphar.2014.00109)

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Background: There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are effectiveness, safety and/or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular atrial fibrillation (AF), exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies showed dabigatran to be cost-effective but there are budget concerns given the prevalence of AF. These concerns resulted in extensive activities pre- to post-launch to manage its introduction. Objective: To (i) review authority activities across countries, (ii) use the findings to develop new models to better manage the entry of new drugs, and (iii) review the implications based on post-launch activities. Methodology: (i) Descriptive review and appraisal of activities regarding dabigatran, (ii) development of guidance for key stakeholder groups through an iterative process, (iii) refining guidance following post launch studies. Results: Plethora of activities to manage dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions and monitoring of prescribing post launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centering on three pillars of pre-, peri-, and post-launch activities. Post-launch activities include increasing use of patient registries to monitor the safety and effectiveness of new drugs in clinical practice. Conclusion: Models for introducing new drugs are essential to optimize their prescribing especially where concerns. Without such models, new drugs may be withdrawn prematurely and/or struggle for funding. © 2014 Godman, Malmström, Diogene, Jayathissa, McTaggart, Cars, Alvarez-Madrazo, Baumgärtel, Brzezinska, Bucsics, Campbell, Eriksson, Finlayson, Fürst, Garuoliene, Gutiérrez-Ibarluzea, Hviding, Herholz, Joppi, Kalaba, Laius, Malinowska, Pedersen, Markovic-Pekovic, Piessnegger, Selke, Sermet, Spillane, Tomek, Vončina, Vlahović-Palčevski, Wale, Wladysiuk, van Woerkom, Zara and Gustafsson.