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Dabigatran Cost-Effective Alternative to Warfarin

Last Updated: November 02, 2010.

Dabigatran, a direct thrombin inhibitor that does not cause hepatotoxicity, may provide a cost-effective alternative to warfarin for preventing strokes in older adults with nonvalvular atrial fibrillation, according to research published online Nov. 1 in the Annals of Internal Medicine.

TUESDAY, Nov. 2 (HealthDay News) -- Dabigatran, a direct thrombin inhibitor that does not cause hepatotoxicity, may provide a cost-effective alternative to warfarin for preventing strokes in older adults with nonvalvular atrial fibrillation, according to research published online Nov. 1 in the Annals of Internal Medicine.

James V. Freeman, M.D., of the Stanford University School of Medicine in California, and colleagues examined the RE-LY randomized trial and other anticoagulation studies to compare quality-adjusted survival, costs, and cost-effectiveness between dabigatran and warfarin for the prevention of ischemic strokes in adults more than 65 years old with nonvalvular atrial fibrillation.

The researchers determined that high-dose dabigatran (150 mg two times daily) was the most cost-effective and most effective therapy evaluated, providing 0.56 quality-adjusted life-years more than warfarin in their base case analysis. The incremental cost-effectiveness ratio of dabigatran compared to warfarin was higher in patients at greater risk for ischemic stroke and intracranial hemorrhage.

"The results of our analysis would change if future effectiveness studies provide alternative estimates for bleeding risk and stroke reduction. Second, a treatment administered in clinical practice may not be as effective as in randomized trials, which generally enroll healthier patients, achieve high levels of adherence, and monitor patients more intensively," the authors write.

Several authors disclosed financial relationships with pharmaceutical or medical companies, including Sanofi-Aventis, Blue Cross Blue Shield, and Generation Health.

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