The most appropriate treatment (s) for patients with atrial fibrillation remains uncertain.
To examine the cost-effectiveness of antithrombotic and antiarrhythmic treatment strategies for atrial fibrillation.
We performed decision and cost-effectiveness analyses using a Markov state transition model.
We gathered data from the English-language literature using MEDLINE searches and bibliographies from selected articles.
We obtained financial data from nationwide physician-fee references, a medical center's cost accounting system, and one of New England's larger managed care organizations.
We examined strategies that included combinations of cardioversion, antiarrhythmic therapy with quinidine, sotalol hydrochloride, or amiodarone, and anticoagulant or antiplatelet therapy.
For a 65-year-old man with nonvalvular atrial fibrillation, any intervention results in a significant gain in quality-adjusted life years (QALYs) compared with no specific therapy.
Use of aspirin results in the largest incremental gain (1.2 QALYs).
Cardioversion followed by the use of amiodarone and warfarin together is the most effective strategy, yielding a gain of 2.3 QALYs compared with no specific therapy.
The marginal cost-effectiveness ratios of cardioversion followed by aspirin, with or without amiodarone, are $33 800 per QALY and $10 800 per QALY, respectively. (...)
Mots-clés Pascal : Fibrillation auriculaire, Coût, Efficacité, Antiarythmique, Anticoagulant, Revue bibliographique, Traitement, Economie, Modèle, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité
Mots-clés Pascal anglais : Atrial fibrillation, Costs, Efficiency, Antiarrhythmic agent, Anticoagulant, Bibliographic review, Treatment, Economy, Models, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0387927
Code Inist : 002B30A04B. Création : 25/01/1999.