title: Stroke prophylaxis with warfarin or dabigatran for patients with non-valvular atrial fibrillation-cost analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Elderly Medicine,  Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD,  UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Ali
authors.forename: Claire
authors.initials: C
authors.lastname: Bailey
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Abdelhafiz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications*; D001562:Benzimidazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D000069604:Dabigatran; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran