Pradaxa

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Praziquantel86

Praziquantel86

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So dabigitran has FDA approval for the prevention of stroke in atrial fibrillation, and there is some pretty good data about VTE treatment/prevention in all sorts of orthopedic procedures. Barring any long-term and unforeseen issues, this looks like a pretty good drug.

What role do you think this will ultimately have in practice? Do you think the inability to monitor therapy will create similar issues to LMWH/UFH? What will be the role of the pharmacist in the delivery of anticoagulation without the need for continuous monitoring?

I think there will necessarily need to be a change in the way pharmacist's approach outpatient anticoagulation, otherwise there are going to be a lot of people out of work. I also don't think warfarin will go away completely or quickly, but within a decade, there will be a change in the way treatment is delivered.

Thoughts?
 
Cost and comfort are going to play a big part in a limited market share over the first few years.

Once large scale pharmacoeconomic dominance is proven I don't see why the newer products can't replace the old- they should and will. If the prescribers hold back, expect evidence-driven for-profit third parties to push the product.

A pharmacist's responsibilities within a health system will change, no doubt- but I don't think there will be a straight layoff of everyone who watches INR's for a living. Healthcare "savings" the Obama administration have been pushing in my mind are tasks like pharmacy dosage monitoring which will continue to be appreciated as proven mechanisms of financial savings.
 
Hospital pharmacists everywhere will need to expand their programs to replace the missing Coumadin consults. They'll need to branch out to more consults other than kinetics... maybe do some TPNs, Epo management and bedside med reconciliation.
 
ethyl said:
Hospital pharmacists everywhere will need to expand their programs to replace the missing Coumadin consults. They'll need to branch out to more consults other than kinetics... maybe do some TPNs, Epo management and bedside med reconciliation.
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And antimicrobial streamlining.

Now...with Pradaxa, if patient bleeds out, how do you reverse it?
 
its z said:
and antimicrobial streamlining.

Now...with pradaxa, if patient bleeds out, how do you reverse it?
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high dose factor seven!!!!!!!!!!!
 
Its Z said:
hmm.. for real? will it work? You have the reversal protocol written out?
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Ha! I have a Blood review by Teddy Warkentin suggesting it as the most useful reversal agent for DTI related bleeding complications. I have not researched it more carefully, though I am sure it is animal data/case reports. Just remembered the article when you asked the question....
 
aight....you finally come through with something useful.
 
Let's see, do I trust big pharma? Not.... I would stay with Warfarin for a while until we see what the post marketing surveillance shows. I'll bet the cost is probably more than Warafrin and monitoring and it's probably not going to be as safe.... Not impressed yet. Let's see:


  • Vioxx
  • Selacryn
  • Zomax
  • Avandia
That's just off the top of my head. I'm a patient person. Let someone else be the Guinea pigs....
 
Old Timer said:
Let's see, do I trust big pharma? Not.... I would stay with Warfarin for a while until we see what the post marketing surveillance shows. I'll bet the cost is probably more than Warafrin and monitoring and it's probably not going to be as safe.... Not impressed yet. Let's see:


  • Vioxx
  • Selacryn
  • Zomax
  • Avandia
That's just off the top of my head. I'm a patient person. Let someone else be the Guinea pigs....
Click to expand...


Trovan
 
Old Timer said:
Let's see, do I trust big pharma? Not.... I would stay with Warfarin for a while until we see what the post marketing surveillance shows. I'll bet the cost is probably more than Warafrin and monitoring and it's probably not going to be as safe.... Not impressed yet. Let's see:


  • Vioxx
  • Selacryn
  • Zomax
  • Avandia
That's just off the top of my head. I'm a patient person. Let someone else be the Guinea pigs....
Click to expand...

Probably? You are being too generous. If it's more expensive than what's the point?
 
owlegrad said:
Probably? You are being too generous. If it's more expensive than what's the point?
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It's all about cost-benefit analysis. Let's say that it is expensive, but it also provides a much greater patient benefit than Warfarin (does Pradaxa have the plethora of DDI's that Warfarin has?), plus the time and money saved from not having to monitor INR. So it's more expensive, but does it improve the health outcomes and quality of life of a patient moreso than Warfarin?
 
IrishHammer said:
It's all about cost-benefit analysis. Let's say that it is expensive, but it also provides a much greater patient benefit than Warfarin (does Pradaxa have the plethora of DDI's that Warfarin has?), plus the time and money saved from not having to monitor INR. So it's more expensive, but does it improve the health outcomes and quality of life of a patient moreso than Warfarin?
Click to expand...

Perhaps I didn't explain my point well enough. What I was getting at is why would a drug company go through the effort of producing a new drug if they didn't plan on selling it at a high price than warfarin. I hope that clears up what I was getting at.
 
I just spoke with a rep on Wednesday. Daily cost is ~$8.
 
I can't WAIT for all the prior authorizations we'll get when this is out.

If there's fewer/no DDIs, no diet interactions, no monitoring/blood draws needed, and fewer bleeds (I thought I read hemorrhagic stroke risk was lower with this), I can see a lot of doctors writing for it. But $4/month for warfarin vs $240 (cash price)... hmm... very interested in seeing a total cost effectiveness comparison.
 
wezvidz said:
I can't WAIT for all the prior authorizations we'll get when this is out.

If there's fewer/no DDIs, no diet interactions, no monitoring/blood draws needed, and fewer bleeds (I thought I read hemorrhagic stroke risk was lower with this), I can see a lot of doctors writing for it. But $4/month for warfarin vs $240 (cash price)... hmm... very interested in seeing a total cost effectiveness comparison.
Click to expand...

Agreed. I think 3rd party pricing is going to have a huge impact on how accepted this is by patients. Putting this in a high tier is going to really slow down its use in the general public.
 
It's not just the cost, although you can do a lot of testing with $240.00/month. The problem is that Coumadin DDI's are just management issues. It will be easier to manage this. What we don't know are the long term effects of this agents. How difficult will it be to treat a patient when the patient is bleeding.

So I really don't see this as a wonder drug and not just for monetary reasons.
 
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