High Pradaxa Price Justified

When using the standard cost-effectiveness threshold of $50,000 for each quality-adjusted life year (QALY) gained, Boehringer Ingelheim can justify asking up to $13.70 per day for its 150-mg dosage of dabigatran (Pradaxa). This conclusion is based on a new cost-effectiveness study, conducted by California- and Michigan-based researchers and supported by the American Heart Association and Veterans Affairs Health Services, in which the incremental benefits of preventing stroke and avoiding warfarin/protime monitoring outweighed a steep price for the new drug and the relatively elevated risks of MI.

Much of this cost-effectiveness analysis was based on data from the massive RE-LY trial and the group of at-risk enrollees with nonvalvular a-fib who were 65 years of age or older. Cost-effectiveness data were also calculated for the 110-mg dosage of dabigatran—which is not available in the United States. A lack of clinical data for the FDA-approved dosage of 75 mg bid (to be used in renally compromised patients) precludes any cost-effectiveness analysis for this regimen.

According to a November 1 press release from the company, the wholesale acquisition price for both FDA-approved doses of dabigatran will be $6.75 a day for 2 capsules (or $202.50 per month): a relative steal. Looks like retail shops can more than double their asking price and still claim a wash with the standard warfarin treatment and its attendant costs. If a post at Cafe Pharma can be believed, Walgreens is asking $169.99 for 60, 150-mg capsules; CVS, $277.99, and Walmart, $232.32.

RE-LY = Randomized Evaluation of Long-term Anticoagulant Therapy.