OBJECTIVES: To assess cost effectiveness of anticoagulant clinics after FDA approval of New Oral Anticoagulants (NOACs) for preventing of ischemic stroke in Atrial Fibrillation (AF) patients in the United States. METHODS: A decision tree was built using outcomes data obtained from randomized clinical trials and publicly available cost data. The analysis compared the cost effectiveness of 150mg dabigatran twice a day taken with no anticoagulation clinic monitoring versus warfarin titrated to dose based upon anticoagulation clinic monitoring. The analysis was for one year using an institutional perspective. The population in this analysis was a cohort of AF patients, ≥ 65 years old, with a mean CHADS score of 2, and no contraindication to anticoagulation. The primary outcomes measured were cost in US$ and Quality Adjusted Life Year (QALY). All data were subject to sensitivity analyses. RESULTS: The base case analysis showed that changing from warfarin to dabigatran without monitoring resulting in an additional $251,000 per QALY saved. Sensitivity analyses found that the model was sensitive to utilities assigned to outcomes and the probability of death. CONCLUSIONS: NOACs claim to reduce the need for anticoagulation monitoring, thereby competing with anticoagulation clinics. This study showed that substituting NOACs for warfarin in this population was not within acceptable willingness to pay values for new therapies. It is likely that anticoagulation clinics will remain a cost effective option in the near future.