Study: Pradaxa use results in higher per-patient costs

Treating patients with Boehringer Ingelheim's blood thinner Pradaxa instead of the old standby warfarin results in significantly higher per-patient costs and net costs per stroke avoided, according to a new study by pharmacy benefit manager Prime Therapeutics.

Pradaxa is used to reduce the risk of stroke and blood clots in certain heart patients. And one of the drug's benefits is that it does not require monthly blood tests to monitor its effectiveness, unlike warfarin. However, according to Prime's analysis, the reduction in regular lab tests doesn't outweigh the significantly higher costs of the drug.

The RE-LY study, which led to FDA approval of Pradaxa, showed the number needed to treat with the drug to prevent one stroke compared with warfarin was 137 patients. Prime found that treating 137 patients with Pradaxa instead of warfarin would result in additional medical and pharmacy costs of $279,617 to avoid one stroke at a cost of $26,407. Total net cost to avoid one stroke would be $253,210, based on the per-patient per-year costs.

"[Pradaxa] (dabigatran) is attractive to patients because of its convenience and potential clinical benefit, but its convenience comes at a high cost," said Patrick Gleason, director of clinical outcomes assessment at Prime, in a statement. "Even when we consider the savings from fewer blood tests, there is a substantial increase in cost to treat patients with dabigatran compared to warfarin to prevent one stroke. Health plans should weigh the benefits and added costs when making decisions about where dabigatran should be placed on a formulary."

The market for blood thinners--which could grow to $20 billion--is hot right now, with many entrants jockeying to become a warfarin alternative. While Pradaxa won the first-to-market prize in the U.S., other options are vying for approval. Bayer ($BAY) and Johnson & Johnson ($JNJ) are looking to hit a home run with Xarelto, and Pfizer ($PFE) and Bristol-Myers Squibb ($BMY) are waiting in the wings with Eliquis.

Although an FDA expert panel recently pummeled Xarelto at a committee meeting, the members voted 9-2 to recommend approval. For its part, Eliquis demonstrated that it was a strong contender, performing far beyond analysts' expectations in recently released study data. The drug was more effective at preventing strokes than warfarin was--and safer, too. Pradaxa doesn't have the superior-to-warfarin label that Eliquis could potentially gain--something that could give Pfizer and BMS an edge with their drug.

- read the Prime release

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