Cost-effectiveness of anticoagulation in nonrheumatic atrial fibrillation in the primary prevention of ischemic stroke.
OBJECTIVE
A number of clinical trials have shown the value of anticoagulating patients with nonrheumatic atrial fibrillation to prevent ischemic stroke. The purpose of this study was to assess the cost-effectiveness of anticoagulation in nonrheumatic atrial fibrillation with particular reference to the very elderly (aged >75 years) who have a higher incidence of bleeding events while undergoing anticoagulation.


METHODS
We calculated the incremental costs per life-year gained for 4 base cases using efficacy data from the Boston Area Anticoagulation Trial for Atrial Fibrillation, the meta-analysis of the 5 nonrheumatic atrial fibrillation trials, cost data from a district general hospital, and review of the literature.


RESULTS
The cost per life-year gained free from stroke over 10 years ranged from -pound sterling 400.45 (ie, a resource saving achieved for each life-year gained free from stroke) to pound sterling 13,221.29. The results were most sensitive to alteration in the frequency of anticoagulation monitoring.


CONCLUSIONS
For medical and economic reasons, anticoagulation treatment in the prevention of ischemic stroke is justified. Although older patients are more at risk of adverse events, anticoagulation is more cost-effective in this group.
Lightowlers
S
S
Department of Geriatric Medicine, Newham General Hospital, London, UK.
McGuire
A
A
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002545:Brain Ischemia / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000191:economics; D002561:Cerebrovascular Disorders / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006801:Humans; D008136:Longevity; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D014859:Warfarin / Q000191:economics* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin