For Medicare Patients, Dabigatran Offers Significant Cost Savings Over Warfarin

Geoffrey Barnes, MD, MSc Clinical Lecturer Cardiovascular Medicine and Vascular Medicine University of Michigan Health System

Dr. Barnes

MedicalResearch.com Interview with:
Geoffrey Barnes, MD, MSc
Clinical Lecturer
Cardiovascular Medicine and Vascular Medicine
University of Michigan Health System

Medical Research: What is the background for this study?

Dr. Barnes: Although warfarin has been the primary anticoagulant used for stroke prevention in atrial fibrillation for over 60 years, four new direct oral anticoagulants (DOACs) have been introduced into the market since 2010. Dabigatran, which directly inhibits thrombin, was found to have better prevention of ischemic stroke and a significant reduction in hemorrhagic stroke (bleeding strokes) for patients with atrial fibrillation at intermediate and high risk of stroke.  Prior cost-effectiveness studies have shown that dabigatran is cost-effective from both the societal and payer (usually Medicare) perspectives.  However, none of those studies looked at the patient’s out-of-pocket costs and the impact of prescription drug coverage

Medical Research: What are the main findings?

Dr. Barnes: We found that patients with prescription drug coverage (Medicare Part D) had significant cost savings when choosing dabigatran over warfarin.  This is primarily because of the reduction in both types of stroke as well not needing to have frequent blood draws, as are required by warfarin.  However, when patients do not have prescription drug coverage, the costs for dabigatran are quite high. 

Medical Research: What should clinicians and patients take away from your report?

Dr. Barnes: Helping patients to make an informed decision about the best oral anticoagulant to take should involve discussions about the out-of-pocket costs.  This study helps to describe what benefits and costs patients might experience depending on their prescription drug coverage status.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Barnes: Future studies need to explore the impact of other forms of prescription drug coverage (e.g. Private insurance providers) and the impact with other oral anticoagulants.  Also, once the status of the Medicare Donut Hole changes based on the Affordable Care Act legislation, the findings of this study will need to be updated.  We also need to explore the impact of an anticoagulant becoming generic, which will likely happen within the next decade.

Citation:

Cost-Effectiveness of Dabigatran (150 mg Twice Daily) and Warfarin in Patients ≥65 Years With Nonvalvular Atrial Fibrillation

Brian M. Salata, MD, MS David W. Hutton, PhD Deborah A. Levine, MD, MPH James B. Froehlich, MD, MPH Geoffrey D. Barnes, MD, MSc

The American Journal of Cardiology
Available online 19 October 2015

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Geoffrey Barnes, MD, MSc (2015). For Medicare Patients, Dabigatran Offers Significant Cost Savings Over Warfarin 

1 Comment
  • Henry Bussey
    Posted at 16:54h, 11 November

    It should be noted that the majority of patients enrolled in these studies were from outside of North America and Western Europe where INR control was better than in the other regional areas where the INR control was so poor (in range 50% of the time or less) that warfarin therapy would be expected to cause more harm than good. Consequently, the study results may not apply to patients managed in the US and Western Europe