What are the cost-effectiveness considerations of newer anticoagulants relative to adjusted-dose warfarin?
The cost-effectiveness of newer anticoagulants relative to adjusted-dose warfarin is predicted to be sensitive to the cost of the medications, the risk for cardioembolism or hemorrhage (cost-effectiveness improving with increasing risk), and the quality of INR control on warfarin. A Markov decision model using data from RE-LY found that dabigatran 150 mg twice daily provided 0.36 additional quality-adjusted life-years at a cost of $9000,407 representing an incremental cost-effectiveness ratio ($25000 per quality-adjusted life-year) that is within the range tolerated by many healthcare systems. These analyses are based on only a single trial of dabigatran, however, and similar evaluations have yet to be performed for rivaroxaban and apixaban.