Comparing cost-effectiveness of warfarin and direct oral anticoagulants for stroke prevention

Written by Alice Weatherston

Patients with irregular heartbeats in the USA face a constant choice between traditional and cheaper therapies, such as warfarin, for preventing stroke, or new direct oral anticoagulants that are more effective but also more expensive. Despite the new drugs appearing to be the most sensible option a new study from the University of Michigan (MI, USA) has for the first time quantitatively analyzed the inherent cost-effectiveness of the two treatment regimens for patients. The research was published online in the American Journal of Cardiology recently.
The research team, led by Geoff Barnes (University of Michigan), looked to take into account measures of effectiveness for stroke prevention, side effects, direct drug costs and monitoring costs for patients on particular treatments and finally the costs of stroke. All aspects were assessed for cost-effectiveness from the patient’s view as well as that of large insurers such as Medicare.

The study focused on the use of anticoagulants in individuals over the age of 65 with atrial fibrillation, directly comparing dabigatran (Pradaxa) to warfarin.

Results indicated that the strongest influence on cost-effectiveness was patients’ pre-existing prescription drug coverage. For those that did not have coverage, direct oral anticoagulants did not provide enough ‘extra’ stroke prevention to make the investment in the expensive drugs worthwhile. Despite this, for patients that did have prescription coverage, a total of ~70% of Medicare participants, direct oral anticoagulants were most cost-effective.

Barnes explained: “in this case, we have a new class of expensive drugs, the direct oral anticoagulants or DOACs, going up against a very inexpensive but less effective drug, warfarin, that requires active monitoring,” he says. “While we found that a newer drug would be more cost-effective for society as a whole, and even cost-saving for people with drug coverage, the picture is very different for those without coverage.”

Importantly the research highlights the need for transparent conversations between doctors and their patients when it comes to decision making on anticoagulant strategies. Barnes commented: “Based on this study, we can give patients and physicians good cost-benefit data to use in that discussion. And studies like this need to inform value-based insurance design.”

While sparking the conversation around drug choice in stroke prevention, the research team also hope that this patient-centric method of cost-effectiveness assessment could also be used for many other expensive new drugs on the market across a variety of diseases.

Source: University of Michigan press release