OBJECTIVES: This economic evaluation aimed to assess the cost-effectiveness of dabigatran etexilate for six months of treatment for acute pulmonary embolism (PE) compared with warfarin and rivaroxaban in the UK healthcare setting. METHODS: A Markov state-transition cohort model was used to project the lifetime recurrence of PE and occurrence of deep vein thrombosis (DVT) in patients with initial acute PE. The incidence of recurrent venous thromboembolism (rVTE) was based on the relevant study endpoints of RE-COVER and RE-COVER II trials comparing dabigatran with warfarin, and the EINSTEIN-PE study for rivaroxaban. Intervention-specific probabilities of events within the composite efficacy endpoint and within the composite safety endpoint of major or clinically relevant bleeding (MCRB) were sourced from the very same randomised trials. Beyond the data from clinical studies, the probability of rVTE was sourced from the published literature. Long-term consequences of VTE were considered, namely chronic thromboembolic-induced pulmonary hypertension and post-thrombotic syndrome. The perspective on costs was that of the NHS and Public Social Services. Health outcomes were assessed in quality-adjusted life years (QALY). Utility values relevant to events and health staes were EQ-5D data from RE-COVER studies, and published literature. Probabilistic sensitivity analyses (PSA) were undertaken. RESULTS: Compared with warfarin, dabigatran projected similar number of rVTE, but was associated with less MCRB. The expected lifetime incremental cost-effectiveness ratios (ICERs) were £2,004/life years (LYs) and £1,285/QALYs. PSA showed 84% likelihood for dabigatran to remain cost-effective given a willingness-to-pay of £30,000/QALY. When compared with rivaroxaban, treatment with dabigatran was projected dominant,. Dabigatran projected less rVTE, less intracranial haemorrhages and clinical relevant non-major bleeds, but was associated with a higher risk of major bleeds. PSA showed 66% likelihood for dabigatran to remain cost-effective over rivaroxaban. CONCLUSIONS: In patients treated for acute pulmonary embolism, dabigatran is a cost-effective alternative compared with both warfarin and rivaroxaban.