• Ali Ali, Claire Bailey, and Ahmed H Abdelhafiz.
• Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
• Age Ageing. 2012 Sep 1;41(5):681-4.

Backgroundcost of anticoagulation with dabigatran is largely based on estimation of complication rates derived from clinical trials.Objectiveto investigate cost of anticoagulation with dabigatran in comparison with warfarin in clinical practice.Methodsa 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.Resultsa 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.Conclusioncost 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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