Wednesday, August 25, 2010

Dabigatran Better Than Dicumoral, But Will Medicare Pay?

I have a number of friends who take Dicumoral (Coumadin, Warfarin), an oral anticoagulant that prevents blood clotting. They share these complaints - the necessity for frequent blood tests to check clotting status; the avoidance of certain foods, such as leafy green vegetables, that affect clotting on patients on Dicumoral; and unexpected bleeding, sometimes minor (hematomas in skin), sometimes major (uncontrollable nosebleeds or massive GI bleeding).

These friends and millions of other Americans who take Dicumoral to prevent venous thrombosis after surgery, coronary artery clotting, and stroke secondary to blood clots in the left atrium with atrial fibrillation, will welcome news of a new drug, Dabigatran (Pradaxa), which is soon to be released in the U.S. and is said to be superior to dicumoral.

Dabigatran has passed its clinical trials. Boehringer Ingelheim, a German pharmaceutical firm, will market the drug, which has been available in Canada and Europe since 2008.

Though much is known clinically about Dabigatran, its likely cost in the U.S. is unknown. In Europe it costs 10 times more than Dicumoral and in Canada the price for ten tablets at one mail order Canadian pharmacy is $77.00 in U.S. dollars.

Whether Medicare will pay for Dabigatran has not been decided. It will be a costly decision. There are 2.3 million Americans with atrial fibrillation, and 15% of 800,000 Americans who have strokes have pre-existing atrial fibrillation. The decision will rest on convenience (blood testing not required), no dietary restrictions (all foods allowed), and safety (fewer bleeding complications) versus higher costs. Most patients with atrial fibrillation are over 65, and the new reform law proposes to cut $575 billion out of Medicare.

Will Dabigatran make the cut?

Source: John Mandrola, MD, “Dabigatran is Superior to Warfarin, But at What Cost?”, April 18, 2010.