OBJECTIVES: To assess cost effectiveness of anticoagulant clinics after FDA approval of New Oral Anticoagulants (NOACs) for preventing ischemic stroke in Atrial Fibrillation (AF) patients in the United States. METHODS: A decision tree was built to compare cost and effectiveness of 150mg dabigatran twice a day to adjusted dose of warfarin within anticoagulation clinic. The analysis was for one year using a societal perspective. The population in this analysis was a cohort of AF patients, ≥ 65 years old, with a CHADS2 score>2, and no contraindication to anticoagulation. RESULTS: The base case analysis showed that changing from warfarin with anticoagulant clinic to dabigatran without monitoring resulted in an additional $82,793 per QALY saved. Sensitivity analyses found that the model was sensitive to utilities of patients on warfarin. CONCLUSION: This study showed that substituting dabigatran for warfarin in this population was not within acceptable willingness to pay values for new therapy.