Cost-effectiveness of preference-based antithrombotic therapy for patients with nonvalvular atrial fibrillation.
Background and Pulpose-Recent atrial fibrillation guidelines recommend the incorporation of patient preferences into the selection of antithrombotic therapy.
However, no trial has examined how incorporating such preferences would affect quality-adjusted survival or medical expenditure.
We compared 10-year projections of quality-adjusted survival and medical expenditure associated with two atrial fibrillation treatment strategies : warfarin-for-all therapy versus preference-based therapy.
The preference-based strategy prescribed whichever antithrombotic therapy, warfarin or aspirin, had the greater projected quality-adjusted survival.
Methods-We used decision analysis stratified by the number of stroke risk factors (history of stroke, transient ischemic attack, hypertension, diabetes, or heart disease).
The base case focused on compliant 65-year-old patients who had nonvalvular atrial fibrillation and no contraindications to antithrombotic therapy.
In patients whose only risk factor for stroke was atrial fibrillation, preference-based therapy improved projected quality-adjusted survival by 0.05 quality-adjusted life year (QALY) and saved $670.
For patients who had atrial fibrillation and one additional risk factor for stroke, preference-based therapy improved quality-adjusted survival by 0.02 QALY and saved $90. (...)
Mots-clés Pascal : Fibrillation auriculaire, Chimioprophylaxie, Accident cérébrovasculaire, Chimiothérapie, Anticoagulant, Warfarine, Etude comparative, Acétylsalicylique acide, Analyse avantage coût, Homme, Coumarine dérivé, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Vaisseau sanguin pathologie, Politique sanitaire, Economie santé
Mots-clés Pascal anglais : Atrial fibrillation, Chemoprophylaxis, Stroke, Chemotherapy, Anticoagulant, Warfarin, Comparative study, Acetylsalicylic acid, Cost benefit analysis, Human, Coumarine derivatives, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Vascular disease, Health policy, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0321243
Code Inist : 002B02G. Création : 27/11/1998.