OBJECTIVES: To estimate the cost-effectiveness of Dabigatran etexilate 150dib relative to Sintrom, Aspirin, Aspitin-Clopidogrel, Best Supportive Care and no treatment, in the management of patients with Atrial Fibrillation in the Greek health care setting. METHODS: A Markov model was adopted to estimate long term outcomes of patients moving during their lifetime in between the following health states: primary and recurrent ischemic stroke, hemorrhagic stroke, transient ischemic attack, systemic embolism, acute myocardial infarction, intracranial hemorrhage, extracranial hemorrhage and death. Data on event rates and patent quality of life associated with different health states and patient survival times were based on a multinational clinical trial (RE-LY) and the related literature. Furthermore, data on resource use associated with the management of patients and of different events were collected from a survey of local hospitals. Unit prices were collected from official resources and relate to 2011. A 3.5% discount rate was used for all outcomes. Sensitivity analysis and probabilistic analysis was used to test the robustness of the analysis RESULTS: The mean total life-time cost of patients on Dabigatran etexilate was estimated at €20,103, relative to €11,639 in the case of Sintrom, while mean Quality Adjusted Life Years (QALYs) were 9.86 and 9.83 for the two treatments, respectively. The incremental cost-effectiveness ratio of Dabigatran etexilate relative to Sintrom was estimated at €25,952. Similarly it was estimated at €8,223,   €10,392 and €7,536 against Asprin-Clopidogrel, Aspirin alone and No-Tretament, respectively. Sensitivity analyses indicated that the cost-effectiveness of Dabigatran etexilate remained below acceptable thresholds (€50,000 per QALY gained) in significant variations of baseline parameters. Probabilistic analysis indicated that in about 85% of cases its cost-effectiveness ratios, relative to the above comparators were below the aforementioned threshold. CONCLUSIONS: Dabigatran etexilate may represent a cost-effective choice for the management of patients with atrial fibrillation in Greece.