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Cost effectiveness of anticoagulation

Cost effectiveness studies are complicated for many, if not most of us. In anticoagulation this seems to be particularly so. Bandolier has sought cost-effectiveness papers in this area, and found some. For the time being these are resisting our attempts to make them simple and understandable. What shines through, though, is that the conclusions are that anticoagulation in AF with the object of reducing strokes is cost effective.

A table of the papers we found follows:

Reference Setting and main findings
Gustafsson et al. Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish National perspective. BMJ 1992 305: 1457-1460. The setting was the Swedish national population assuming 83,000 with AF, 22,000 of whom would be candidates for anticoagulants and 55,000 for aspirin. Concluded that treatment cost effective provided that complications of anticoagulants is kept low.
Alexandrov et al. Cost considerations in the pharmacological prevention and treatment of stroke. Pharmacoeconomics 1997 11: 408-418. Review examining cost effectiveness of various risk factor modification, and treatments. Concludes that complication rate with warfarin and tPA must be kept low to achieve cost benefits.
Lightowlers & McGuire. Cost-effectiveness of anticoagulation in nonrheumatic atrial fibrillation in the primary prevention of ischaemic stroke. Stroke 1998: 29: 1827-1832. Calculated incremental cost effectiveness ratios from four base cases based on trials and meta-analysis. Calculated cost per life year gained over 10 years to be cost saving (£400) to £13,200. Results most sensitive to frequency of anticoagulant monitoring.
Teng et al. Cost effectiveness of therapies for atrial fibrillation. Pharmacoeconomics 2000 18: 317-333. Reviews findings of cost effectiveness studies since 1990. Most interventions have favourable economics. Also discusses merits and limitations of cost effectiveness analyses. Identifies areas for additional research.
Parry et al. Anticoagulation management in primary care: a trial-based economic evaluation. British Journal of Haematology 2000 111: 530-533. Evaluates cost effectiveness of primary care versus hospital monitoring and care anticoagulation management. Primary care cost more (£170 per patient per year) than hospital (£69). Based on data from RCT.