Cost of dabigatran for atrial fibrillation

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6980 (Published 31 October 2011) Cite this as: BMJ 2011;343:d6980
  1. Brian F Gage, associate professor of medicine
  1. 1Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO 63110, USA
  1. bgage{at}dom.wustl.edu

Cost effective in patients at high risk of stroke, unless INR is well controlled

Because atrial fibrillation is associated with advanced age and obesity, its prevalence is increasing worldwide.1 New treatments such as ablation and left atrial occlusion may reduce the need for anticoagulants in highly selected patients with atrial fibrillation, but overall the use of anticoagulants will increase in the foreseeable future. In the linked study (doi:10.1136/bmj.d6333), Pink and colleagues assess the incremental costs and benefits of dabigatran etexilate versus warfarin in patients with non-valvular atrial fibrillation.2

Until recently, warfarin and related vitamin K inhibitors have been the only oral anticoagulants available. Warfarin is cheap and effective, but it doubles the risk of haemorrhage, requires careful monitoring, and has many drug interactions.3 Compared with warfarin, dabigatran has a wide therapeutic index, so no monitoring or dose adjustment is needed (except in patients with renal disease). Dabigatran works by inhibiting thrombin directly, so its onset of action is rapid, unlike warfarin. To date, dabigatran is the only new oral anticoagulant approved for atrial fibrillation in several countries, including the United States. Thus, dabigatran has the potential to be widely prescribed.

The potential economic consequences of …

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