Using a decision-analytic model, we sought to examine the cost-effectiveness of three strategies for cardioversion of patients admitted to the hospital with atrial fibrillation.
Transesophageal echocardiographic (TEE) - guided cardioversion has been proposed as a method for early cardioversion of patients with atrial fibrillation.
The cost-effectiveness of this approach, relative to conventional therapy, has not been studied.
We ascertained the cost per quality-adjusted life-year (QALY) of three strategies : 1) conventional therapy-transthoracic echocardiography (TTE) and warfarin therapy for 1 month before cardioversion ; 2) initial TTE, followed by TEE and early cardioversion if no thrombus is detected ; 3) initial TEE, with early cardioversion if no thrombus is detected.
With strategies 2 and 3, if a thrombus is seen, follow-up TEE is performed.
If no thrombus is seen, cardioversion is then performed.
All strategies utilized anticoagulation before and extending for 1 month after cardioversion.
Life expectancy, utilities (quality-of-life weights) and event probabilities were ascertained from published reports.
Cost estimates were based on published data and hospital accounting information.
Transesophageal echocardiographic-guided early cardioversion (strategy 3 : cost $2,774, QALY 8.49) dominates TTE/TEE-guided cardioversion (strategy 2 : cost $3,106, QALY 8.48) and conventional therapy (strategy 1 : cost $3,070, QALY 8. (...)
Mots-clés Pascal : Fibrillation auriculaire, Cardioversion, Echocardiographie, Transducteur ultrason, Oesophage, Guidage, Analyse coût efficacité, Economie santé, Traitement, Homme, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité, Réanimation cardiocirculatoire, Traitement instrumental, Exploration ultrason
Mots-clés Pascal anglais : Atrial fibrillation, Cardioversion, Echocardiography, Ultrasonic transducer, Esophagus, Guidance, Cost efficiency analysis, Health economy, Treatment, Human, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder, Intensive cardiocirculatory care, Instrumentation therapy, Sonography
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0142564
Code Inist : 002B12A02. Création : 21/05/1997.