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Newly approved drug appears to provide more cost-effective stroke prevention than warfarin

The blood-thinner warfarin isn't the most universally loved medication in the world. The drug, which is commonly prescribed to people with certain heart conditions, can be quite effective at preventing blood clots. But it also carries risks (too little and it could fail to be effective, too much and it could lead to serious or fatal hemorrhage), and people taking the medication face constant blood testing and dose adjustment.

“Among my patients, I get asked about alternatives to warfarin a dozen times a week,” Mintu Turakhia, MD, MAS, a cardiac electrophysiologist with Stanford and the Veterans Affairs Palo Alto Health Care System, recently told me. “Many of them are just unhappy with the need for regular, often lifelong blood testing.”

Last month the FDA approved an alternative - the drug dabigatran, marketed as Pradaxa - to prevent stroke in patients with an irregular heart rhythm. (This followed a large study showing the drug, which requires no blood testing, was about as effective as warfarin in preventing strokes but less likely to cause hemorrhages.) And now there is more potentially promising news about the therapy: According to a study led by Turakhia, using the drug to prevent stroke appears to be cost-effective, depending on pricing, and dabigatran may also offer patients better health outcomes than warfarin.

To come to this conclusion, Turakhia and colleagues developed a mathematical model that simulated 10,000 older patients with atrial fibrillation and risk factors for stroke, and compared outcomes and costs of warfarin and two different doses of dabigatran. They found that the high-dose dabigatran yielded an additional 0.56 quality-adjusted-life-year - a common metric that takes into account quality of life as well as length of survival - and came at an incremental cost over warfarin of $45,372 per quality-adjusted-life-year - well below the commonly accepted cost-effective threshold of $50,000.

Dabigatran is the first new drug in two decades to be approved for stroke prevention in atrial fibrillation, and Turakhia said it was exciting that it appears to be both therapeutically effective and cost-effective. His hope is that the findings, which appear in the Annals of Internal Medicine, will help guide decisions by physicians, insurance payers and policy-makers about the medication.

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