Beyond the sticker shock of Warfarin alternatives

Analysis shows costs savings without frequent blood draws and fewer complications

Pills spillDoctors who are worried about the risk of stroke among their patients with the abnormal heart rhythm atrial fibrillation often look to anticoagulants for help – medicines that prevent dangerous blood clots, but can cost a lot.

Cardiovascular specialists at the University of Michigan Frankel Cardiovascular Center looked at the cost of dabigatran (Pradaxa) which is part of the new class of anticoagulants. They are simpler to use and less risky than Warfarin.

Medicare will spend an average of $75,496 to cover the cost of dabigatran for a 65-year-old with Medicare Part D coverage, compared to Warfarin’s cost of about $61,586. Research by the University of Michigan presented at this week’s American Heart Association scientific sessions reveals that in spite of the price tag, the new medicines can be cost-effective.

“Dabigatran is considered very expensive, which is a deterrent for many patients even with prescription drug coverage,” says Geoff Barnes, M.D., cardiologist at the University of Michigan Frankel Cardiovascular Center. “However our analysis includes the time-related costs associated with frequent blood draws as well as the reduced risk of complications when they choose dabigatran.”

Warfarin vs. dabigatran

While often called blood thinners, anticoagulants actually reduce the blood’s ability to clot. The downsides of warfarin, according to Barnes, include food and drug interactions, and needing to have your blood checked frequently. No monitoring is needed with dabigatran.

Vegetables that are high in Vitamin K, such as cauliflower, cabbage and broccoli, counteract warfarin. Warfarin is also known to have many drug interactions, including with non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin.

The drawbacks to dabigatran include the expense compared to warfarin and the requirement of two doses per day, where warfarin only involves one daily pill.

The cost is offset because dabigatran does not require monitoring, according to the analysis that also took in to account the cost of fewer heart attacks, strokes and hospitalizations. All contributed to a $35,000 costs savings between dabigatran and warfarin.

Consult your doctor

Barnes collaborated on the research with University of Michigan medical student Brian Salata, along with specialists James Froehlich, M.D., who leads the University of Michigan anticoagulation service, David W. Hutton, Ph.D., and Deborah A. Levine, M.D., M.P.H.

The analysis should help doctors have discussions with their patients.

“But if patients can get prescription drug coverage, then it’s probably worth some extra out-of-pocket money to pay for dabigatran compared to warfarin because of the savings without frequent blood draws and fewer complications,” Barnes says.

Take the next steps


Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is a top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at umcvc.org.