Patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery are considered to be at high risk of venous thromboembolism (VTE). The current gold standard of care in prevention of VTE (thromboprophylaxis) in these patients is low-molecular-weight heparin (LMWH), which is delivered by subcutaneous injection. Dabigatran etexilate (DBG) is a novel, direct thrombin inhibitor which is administered orally and does not require any monitoring. OBJECTIVES: To evaluate the budgetary impact of DBG in local health economies. METHODS: Phase-III trials demonstrated that DBG is as effective and safe as enoxaparin (LMWH). Therefore this study concentrated on thromboprophylaxis costs most likely to change dependant on the choice of thromboprophylactic, namely, medication acquisition and administration. An interactive model was developed, whereby the user can select a local health economy (e.g. acute trust, NHS/independent centre, primary care organisation etc.) anywhere in the UK and assess the budgetary impact of the introduction of DBG based on local THR/TKR procedure data. Several other inputs may also be defined, including current practice, take-up, ability to self-administer, treatment duration and strategy. Unit costs were derived from standard sources; other inputs were derived from the published literature. RESULTS: Under default assumptions, results for a large hypothetical centre performing 500 THR and 500 TKR procedures per year reveal that although the medication acquisition costs of DBG and LMWH are similar, the introduction of DBG could potentially save up to 1500 community nurse visits per annum. This translates into a budget savings of approximately £44,000. CONCLUSIONS: Compared with LMWH, centres that switch patients to DBG may decrease the financial burden placed on the local health economy by current recommended practice in thromboprophylaxis following THR and TKR. Through removal of costly administration, education and home visits associated with LMWH, the resource savings could be considerable.