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  1. A cost-effectiveness analysis of aspirin versus oral anticoagulants after acute myocardial infarction in Italy : Equivalence of costs as a possible case for oral anticoagulants.

    Article - En anglais

    Aims

    The recent publication of two large trials of secondary prevention of coronary artery disease with oral anticoagulants (WARIS and ASPECT) has caused a revival of the interest for this antithrombotic therapy in a clinical setting where the use of aspirin is common medical practice.

    Despite this, the preferential use of aspirin has been supported by an American cost-effectiveness analysis (JAMA 1995 : 273 : 965).

    Methods and Results

    Using the same parameters used in that analysis and incidence of events from the Antiplatelet Trialists Collaboration and the ASPECT study, we re-evaluated the economic odds in favor of aspirin or oral anticoagulants in the Italian Health System, which differs significantly in cost allocation from the United States system and is, conversely, similar to other European settings.

    Recalculated costs associated with each therapy were 2.150 ECU/patient/year for oral anticoagulants and 2,187 ECU/patient/year for aspirin.

    In our analysis, the higher costs of oral anticoagulants versus aspirin due to a moderate excess of bleeding (about 10 ECU/patient/year) and the monitoring of therapy (168 ECU/patient/year) are more than offset by an alleged savings for recurrent ischemic syndromes and interventional procedures (249 ECU/patient/year).

    Conclusions

    Preference of aspirin vs. oral anticoagulants in a pharmaco-economical perspective is highly dependent on the geographical situation whereupon calculations are based. (...)

    Mots-clés Pascal : Infarctus, Myocarde, Traitement, Anticoagulant, Etude comparative, Analyse coût efficacité, Acétylsalicylique acide, Voie orale, Inhibiteur thromboagrégation, Economie santé, Italie, Europe, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie

    Mots-clés Pascal anglais : Infarct, Myocardium, Treatment, Anticoagulant, Comparative study, Cost efficiency analysis, Acetylsalicylic acid, Oral administration, Antiplatelet agent, Health economy, Italy, Europe, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0019883

    Code Inist : 002B02G. Création : 31/05/1999.