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A generous price for a drug that offers no therapeutic advantage

A hefty price has just been agreed for ximelagatran, a new anticoagulant, whereas older anticoagulant treatments are better evaluated and have a favourable benefit-harm balance.

An anticoagulant is administered to prevent venous thromboembolic events in patients undergoing orthopaedic surgery. Two well-evaluated treatments, low molecular weight heparin such as enoxaparin, or a vitamin K antagonist such as warfarin, offer a favourable benefit-harm balance. The new anticoagulant ximelagatran, which is now 65% refundable by French Social Security, carries a very high price in France: €5.70 per day of treatment. And yet in 2004, the French Pharmacoeconomic Committee considered that this anticoagulant offered no advantage compared with enoxaparin. It also requested that ximelagatran be made available in packs of 2 tablets and not 10 as it is now (home treatment of most patients should be less than 5 days). There is still a huge question mark over the hepatic and cardiac risks posed by ximelagatran. Another disadvantage of ximelagatran is that this anticoagulant has no known antidote (necessary in the event of overdose), whereas specific antidotes are available for heparins and vitamin K antagonists. ©Prescrire September 2005

Source: "Ximélagatran remboursable, au prix fort" Rev Prescrire 2005 ; 25 (264) : 578-579.

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