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Updated: May 24, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Stroke prophylaxis with warfarin or dabigatran for patients with non-valvular atrial fibrillation-cost analysis
Ali Ali1, Claire Bailey, Ahmed H Abdelhafiz
1Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
Insights
Warfarin is more cost-effective than dabigatran for non-valvular atrial fibrillation (NVAF) anticoagulation in clinical practice. Dabigatran
Area of Science:
- Pharmacoeconomics
- Cardiology
- Clinical Practice
Background:
- Anticoagulation cost estimations for dabigatran often rely on clinical trial data.
- Real-world cost-effectiveness in clinical practice requires further investigation.
Purpose of the Study:
- To compare the costs of dabigatran versus warfarin for anticoagulation in a clinical setting.
- To analyze drug, monitoring, and bleeding-related expenses.
Main Methods:
- Prospective observational study of non-valvular atrial fibrillation (NVAF) patients.
- Telephone interviews assessed bleeding events over a mean follow-up of 19 months.
- Cost analysis included drug, INR monitoring, and bleeding costs.
Main Results:
- Annual anticoagulation cost per patient was £207.3 for warfarin and £1,573.5 for dabigatran.
- Drug price represented 13.6% of warfarin costs and 94% of dabigatran costs.
- Preventing one stroke annually cost £6,219 for warfarin, £28,086.5 for dabigatran 110 mg, and £25,181 for dabigatran 150 mg.
Conclusions:
- Dabigatran's cost is primarily driven by drug price; warfarin's by INR control quality.
- Warfarin remains a suitable option for most NVAF patients until dabigatran pricing is revised.
Background:
cost of anticoagulation with dabigatran is largely based on estimation of complication rates derived from clinical trials.
Objective:
to investigate cost of anticoagulation with dabigatran in comparison with warfarin in clinical practice.
Methods:
a prospective observational study of patients with non-vavular atrial fibrillation (NVAF) referred to anticoagulation clinic. Patients were interviewed (4-6 weekly by telephone) about bleeding events. Costs of anticoagulation were calculated as: (i) drug cost, (ii) international normalised ratio (INR) monitoring cost and (iii) bleeding cost. For cost calculation of dabigatran, INR monitoring cost was omitted.
Results:
a total of 402 patients were included and followed up for a mean (SD) of 19 (8.1) months. Annual cost of anticoagulation was £207.3 and £1,573.5 per patient for warfarin and dabigatran, respectively. Drug price constituted 13.6% of the total cost for warfarin and 94% for dabigatran. Total cost of anticoagulation to prevent one stroke per year was £6,219, £28,086.5 and £25,181 for warfarin, dabigatran 110 and 150 mg, respectively.
Conclusion:
cost of anticoagulation is mainly driven by drug price for dabigatran and quality of INR control for warfarin. Until the price of dabigatran is reviewed, warfarin remains suitable for the majority of patients with NVAF.
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