TO THE EDITOR:
Freeman and colleagues' cost-effectiveness analysis of dabigatran versus warfarin (1) accurately assessed the associated costs for payers of health care but not the true costs of care. The authors assumed that the costs of treating major hemorrhage would be identical to the 2008 Centers for Medicare & Medicaid Services diagnosis-related group reimbursement rates for both groups. This is not accurate. Fresh frozen plasma and vitamin K can treat severe bleeding due to warfarin. No reversal agent for dabigatran exists, but some investigators recommend recombinant activated factor VIIa (2), a substantially more expensive alternative than FFP or vitamin ...
References
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Freeman JV ,Zhu RP ,Owens DK ,Garber AM ,Hutton DW ,Go AS ,et al . Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med. 2011;154:1-11. [PMID:21041570 ] LinkGoogle Scholar - 2.
van Ryn J ,Stangier J ,Haertter S ,Liesenfeld KH ,Wienen W ,Feuring M ,et al . Dabigatran etexilate—a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103:1116-27. [PMID:20352166 ] CrossrefMedlineGoogle Scholar - 3.
Connolly SJ ,Ezekowitz MD ,Yusuf S ,Eikelboom J ,Oldgren J ,Parekh A ,et al ;RE-LY Steering Committee and Investigators . Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51. [PMID:19717844 ] CrossrefMedlineGoogle Scholar - 4.
Edwards DB ,Heisler M ,Guidry J ,Jordan RM . Adverse drugs events leading to admission at a community non-teaching hospital. J Clin Outcomes Manag. 2007;14:389-94. [PMID:19717844 ] MedlineGoogle Scholar
Author, Article and Disclosure Information
From Banner Gateway Medical Center, Gilbert, AZ 85234.
Disclosures: None disclosed.
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