Cost-effectiveness of anticoagulation in nonrheumatic atrial fibrillation in the primary prevention of ischemic stroke.
نویسندگان
چکیده
BACKGROUND AND PURPOSE A number of clinical trials have shown the value of anticoagulating patients with nonrheumatic atrial fibrillation to prevent ischemic stroke. The purpose of this study was to assess the cost-effectiveness of anticoagulation in nonrheumatic atrial fibrillation with particular reference to the very elderly (aged >75 years) who have a higher incidence of bleeding events while undergoing anticoagulation. METHODS We calculated the incremental costs per life-year gained for 4 base cases using efficacy data from the Boston Area Anticoagulation Trial for Atrial Fibrillation, the meta-analysis of the 5 nonrheumatic atrial fibrillation trials, cost data from a district general hospital, and review of the literature. RESULTS The cost per life-year gained free from stroke over 10 years ranged from -pound sterling 400.45 (ie, a resource saving achieved for each life-year gained free from stroke) to pound sterling 13,221.29. The results were most sensitive to alteration in the frequency of anticoagulation monitoring. CONCLUSIONS For medical and economic reasons, anticoagulation treatment in the prevention of ischemic stroke is justified. Although older patients are more at risk of adverse events, anticoagulation is more cost-effective in this group.
منابع مشابه
Deciding on anticoagulating the oldest old with atrial fibrillation: insights from cost-effectiveness analysis.
OBJECTIVES To better understand the tradeoffs between the efficacy of anticoagulation with warfarin and its side effects in the oldest old with nonrheumatic atrial fibrillation (AF). DESIGN Cost-effectiveness analysis. SETTING Published literature, including meta-analyses when available, and web-based sources. PARTICIPANTS Those aged 65 to 100 with AF. INTERVENTION Anticoagulation with ...
متن کاملAntithrombotic therapy in atrial fibrillation.
Abbreviations: ACUTE 5 Assessment of Cardioversion Using Transesophageal Echocardiography; AF 5 atrial fibrillation; AFASAK 5 Atrial Fibrillation Aspirin and Anticoagulation; AFI 5 Atrial Fibrillation Investigators; BAATAF 5 Boston Area Anticoagulation Trial for Atrial Fibrillation; CAFA 5 Canadian Atrial Fibrillation Anticoagulation; CI 5 confidence interval; DC 5 direct current; EAFT 5 Europe...
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BACKGROUND The rate of stroke in atrial fibrillation (AF) depends on the presence of comorbid conditions and the use of antithrombotic therapy. Although adjusted-dose warfarin is superior to aspirin for reducing stroke in AF, the absolute risk reduction of warfarin depends on the stroke rate with aspirin. This prospective cohort study tested the predictive accuracy of 5 stroke risk stratificati...
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BACKGROUND AND PURPOSE Stroke outcomes in patients with atrial fibrillation (AF) tend to be worse than those in patients without AF. The objective of this study was to evaluate whether the cost benefits of anticoagulation for stroke prevention in AF may currently be underestimated by existing economic models that do not distinguish between different stroke outcomes. METHODS A literature revie...
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عنوان ژورنال:
- Stroke
دوره 29 9 شماره
صفحات -
تاریخ انتشار 1998