Warfarin has been approved by the FDA since 1954 and is available in inexpensive generic forms that can cost as little as $4 a month. Warfarin can reduce stroke in AF patients by more than 50% and reduces absolute risk of stroke per year by 2%. Patients taking warfarin require frequent monitoring with blood tests and there are high medical costs associated with potential complications from over- or under-anticoagulation.
Alternative newer agents such as dabigatran, apixaban, rivaroxaban, and edoxaban are also available for treatment and prevention of stroke and hemorrhage in AF patients.  Unlike on warfarin, patients taking these NOACs do not require regular monitoring. NOACs are, however, more expensive than warfarin. The debate regarding the cost-effectiveness of NOACs is ongoing, as it depends on the drugs’ price, risk of bleeding, and quality-of-life for patients taking the medication. Multiple studies have demonstrated that overall NOACs are cost-effective medications compared to warfarin among patients with poor control of international normalized ratio (INR) with warfarin or with an increased risk of stroke or hemorrhage.
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