OBJECTIVES: To analyse the budgetary impact (BI) of the introduction of NOAC in patients with NVAF compared to warfarin treatment scenario (DC) from the perspective of the public health system of Extremadura (PHSE). METHODS: A budget impact study was performed during 2013. It was based on anticoagulant therapy (AO) on patients with NVAF. The data came from the electronic clinical history called JARA®. Pharmaceutical costs associated to the control and monitoring of patients with DC were included. Specifically those related to the incidence of stroke (CVA), gastrointestinal haemorrhage (HG), intracranial haemorrhage (ICH) and acute myocardial infarction (AMI) as the RE-LY, ROCKET and ARISTOTLE trials. For DC, there were taken into account the best and worst scenario. The pharmaceutical cost considered was the sum of the official price and the VAT. To other public health costs, official prices from the PHSE and the Spanish National Health Care System were considered. RESULTS: Treatment distribution among patients was 92.63% DC; 4.02% Dabigatran (DAB); 3.07% rivaroxaban (RIV) and 0.28% Apixaban (APX). The total expenditure for the AO patients with VKA in the best scenario is € 3,036,604.28 (average cost per patient: € 342.11, CI 95%: 341.89 - 342.34) and the worst would be € 3,727,169 (€ 419.92, CI 95%: 419.70 - 420.15). For NOAC the results are € 572,515.39 (€ 810.93, CI 95%I: 786.71 - 835.16). NOAC represent the 71.44% of the pharmaceutical expenditure (PE), the 23.47% of PE’s control and monitoring of DC and the 15.86% of the total expenditure from AO patients with NVAF, in the best scenario. CONCLUSIONS: The market access of NOAC has been modest and similar to the rest of Spain. AVK alternative has the lowest average cost per patient.  Limitation: safety data has been obtained from clinical trials instead of using clinical practice.