Table 8.

Cost-effectiveness of new agents.

Cost will be a major barrier to use for the new agents Warfarin is an established and cheap generic drug Only dabigatran has been compared to warfarin in cost-effectiveness analyses, both with favourable results for the new drug One analysis136 suggested high-dose dabigatran was cost-effective as long as the cost was less than $13.70 (roughly double the current US pricing) A further analysis137 suggested that dabigatran was cost-effective in high-risk stroke patients unless they had exceptionally good INR control Cost-effective analyses based on trial data may not reflect real-world clinical practice Collateral costs (including physician time for dose-adjustments and patient transport to clinics) must be incorporated into future analyses More experience with the new agents is mandatory before meaningful conclusions on their cost-effectiveness can be made