Weighing up blood-thinners: Is warfarin always best?

A study published in the Journal of General Internal Medicine guides clinicians and policy makers on the relative cost-effectiveness of various anticoagulant (blood-thinning) drugs. The research, carried out by Joyce You of the Chinese University of Hong Kong, suggests that although newer anticoagulants are generally more expensive than the commonly used warfarin, in the long run they may in fact be more cost-effective.

A patient’s intake of vitamin K as well as the influence of other medications both determine warfarin’s effectiveness. Regular blood tests are necessary as incorrect dosages can, in some cases, lead to excessive bleeding. Previous studies have already shown that new oral anticoagulants such as dabigatran, rivaroxaban and apixabanare can be as effective as warfarin in treating strokes, but can also cause bleeding in patients if not used correctly.

In her study, You compared the life-long economic treatment outcomes of warfarin against these newer alternatives. She measured the cost of specific treatments as well as how often a person would have to undergo cumbersome blood tests to ensure the effectiveness of said treatment. Her results were based on an analysis of a hypothetical group of 65-year old people suffering from atrial fibrillation (a heart rhythm disorder) as well as additional information from previous clinical trials.

You concluded: “The acceptance of the new oral anticoagulants as a more cost-effective option than warfarin therapy is highly dependent on the level of anticoagulation control achieved by warfarin therapy, cost for anticoagulation service to manage patients on warfarin, and drug cost of the new oral anticoagulants.”

Link: http://www.springer.com/about+springer/media/springer+select?SGWID=0-11001-6-1440945-0