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Pricey New Blood Thinner Could Be A Deal

When is an $8-a-day drug a bargain compared with one that costs just a dollar?

Could be when the cheaper drug requires lots of testing and fiddling with the dose to make sure there's enough of it in the bloodstream enough to prevent clots but not so much as to hurt a patient — and the higher-priced drug doesn't.

That's the thinking about a just-approved drug called dabigatran (brand name Pradaxa) to prevent blood clots and strokes –- the first new stroke-prevention drug in two decades.

Dabigatran will compete with warfarin (Coumadin and other brands) for the prevention of clots.

It's a huge market. More than two million Americans have a heart condition called atrial fibrillation that puts them at high risk of arterial blood clots, the cause of most strokes. More than 100,000 strokes a year are caused by a-fib.

Warfarin costs about $1 a day for the medication alone. And the price of dabigatran at the pharmacy will be about eight times higher.  But a Stanford research team (which has no financial ties to Boehringer Ingelheim, maker of dabigatran) figures the new drug is actually a better deal. Their analysis was published recently in the Annals of Internal Medicine.

When the Stanford group took the costs of blood tests and physician monitoring into account, they found that the cost of prescribing dabigatran doesn't look so high compared to putting a patient on warfarin.

One way they looked at it is through the lens of quality-adjusted life years, or QALYs. That's how much additional good-quality life a particular therapy buys, and at what cost.

Dr. Mintu Turakhia says the Stanford group found that dabigatran, at the US price of about $7.90 a day, costs around $12,000 for each additional year of good-quality life.

That's "very, very low," Turakhia says. He points out that the usual line in the sand that separated good and poor value is $50,000 for each additional year of good-quality life. (That's roughly the cost of kidney dialysis, which Medicare and other insurers consider acceptable.)

But, perhaps inevitably, there is a tradeoff. While dabigatran prevents strokes as well as warfarin, and it's less likely to cause a hemorrhage, it poses a somewhat higher risk of heart attacks.