Costs and effects of long-term oral anticoagulant treatment after myocardial infarction.

OBJECTIVE To investigate the costs and effects of long-term oral anticoagulant treatment after myocardial infarction. DESIGN Cost-effectiveness analysis, based on a randomized, double-blind, placebo-controlled trial. SETTING Sixty Dutch hospitals. PATIENTS A total of 3404 hospital survivors of acute myocardial infarction randomized within a median period of 4 days after discharge to either oral anticoagulant treatment or placebo. The mean follow-up was 37 months. INTERVENTION Oral anticoagulant treatment aimed at a target international normalized ratio of 2.8 to 4.8. MAIN OUTCOME MEASUREMENTS Costs of hospital stay during readmissions, costs related to major cardiologic interventions, and costs of oral anticoagulant treatment. RESULTS The costs of oral anticoagulant treatment were estimated at 394 Dutch guilders (Dfl) per patient-year (Dfl 1 = US $0.58). Placebo patients stayed 18,830 days in the hospital compared with 15,083 days for anticoagulation patients. Average costs per patient of medical care during follow-up were estimated at Dfl 10,784 for placebo patients and Dfl 9878 for anticoagulation patients. CONCLUSIONS Costs of long-term anticoagulant treatment are outweighed by the costs of prevented clinical events.