The new oral anticoagulants, dabigatran, rivaroxaban, and apixaban, are likely to yield additional health benefits in terms of quality-adjusted life-years as compared with warfarin.

Differences in health gains are, however, relatively small and prices are high.

Sequential dabigatran (150 mg up to age 80 years, thereafter 110 mg as recommended by the European Society of Cardiology) is the strategy most likely to be considered cost effective, regardless of risk group.

When reducing the dabigatran dosage at age 75 years (instead of at age 80 years), apixaban becomes the most effective and cost-effective alternative.

Conclusions are highly dependent upon assumptions made in the analysis.