Heart Health

Comparing Old and New Drugs for AFib in People Age 65+

When it comes to preventing stroke, millions of Americans with irregular heartbeats (atrial fibrilation or AFib) face a choice: Take one of the powerful but pricey new pills they see advertised on TV, or a much cheaper 60-year-old drug that can be a hassle to take, and doesn’t prevent stroke as well.

It doesn’t seem like much of a contest — until you do the math, which a University of Michigan Medical School team has just done. The study focused on the use of clot-preventing blood thinner drugs called anticoagulants in patients over age 65 who have a condition called atrial fibrillation that raises stroke risk greatly. The researchers published their results online in November 2015 in the American Journal of Cardiology.

A release from the university reports that the researchers looked at how cost-effective the two choices are from a patient’s-eye view, as well as the viewpoint of insurers such as Medicare. They took into account how well the drugs prevent stroke, the side effects they both cause, the cost of the drugs and the monitoring, and the cost of caring for a stroke.

In the end, they found, the prescription drug coverage a patient has matters most.

Those without coverage, who could pay thousands of dollars out of pocket for the newer drug, may not get enough extra stroke-preventing benefit to make the money worthwhile to them.

But for the 70 percent of Medicare participants who buy extra insurance coverage to help them pay for prescriptions, the newer drugs are probably worth it even though their insurance plan may charge more for them. That means doctors and patients need to work together to choose carefully based on their individual circumstances and coverage.

The method the researchers developed could go far beyond studying these drugs. With so many pricey new drugs on the market for other diseases and conditions, the same approach could be used for other studies that put the patient first.

Warfarin vs. direct oral anticoagulants

Most cost-effectiveness studies compare two similar drugs, and look at costs and benefits from a societal or insurance viewpoint rather than the patient’s viewpoint, says Geoff Barnes, M.D., M.Sc., a cardiologist at U-M’s Frankel Cardiovascular Center who led the study and has studied the rise of the new drugs.

The release quotes Barnes as saying, “But in this case, we have a new class of expensive drugs, the direct oral anticoagulants or DOACs, going up against a very inexpensive but less effective drug, warfarin, that requires active monitoring. While we found that a newer drug would be more cost-effective for society as a whole, and even cost-saving for people with drug coverage, the picture is very different for those without coverage.”

The study compared the DOAC drug dabigatran, sold as Pradaxa, to warfarin. There are three other DOACs on the market. DOACs don’t require blood tests or diet changes, don’t interact with other drugs, and have other advantages over warfarin.