OBJECTIVES: We analysed the value for money of warfarin and direct-acting oral anticoagulants (DOACs), both of which are effective and recommended in treatment guidelines for prevention of stroke in atrial fibrillation, but for which pricing differs. METHODS: The Socio-Technical Approach to Resource Allocation (STAR) method developed by LSE and Oxford Universities estimates value for money from treatments costs, the number of patients treated, and number of patients who benefit. Based on evidence from the National Health and Care Excellence guidelines on use of oral anticoagulants, we assessed various hypothetical market share scenarios, starting at 80% warfarin and 20% DOACs and decreasing or increasing each by 10% until reversed (20% warfarin/80% DOACs). We also assessed value for money by forecast changes to current prescribing, spending, and market shares. RESULTS: With an 80% warfarin/20% DOAC market share, total spend would be £290 million: £182 million (63%) for 629,000 patients receiving warfarin and £109 million (37%) for 157,000 patients receiving DOACs. With the reversed market share, the total spend would be £479 million (difference 66%): £45 million (9%) for 157,000 patients receiving warfarin and £434 million (91%) for 629,000 patients receiving DOACs. Owing to similar quality-adjusted life-years (warfarin 0.204, DOACs 0.208), however, population health gain would only be 1.27%. Overall oral anticoagulant spending is forecast to increase by 102% and achieve a population health gain of 44% by 2020/21. Meanwhile, the DOAC market share is predicted to increase from 59% to 93%. With no market share change, expenditure of £236 million (29%) less would still achieve 44% population health gain. With the market share change, therefore, the cost of DOACS would need to fall by £218 million (29%) to match this saving. CONCLUSIONS: The price of DOACs will need to fall substantially to maintain value for money under current projections.