From the Department of Geriatric Medicine, Newham General Hospital and St
Andrew's Hospital (S.L.), and Department of Health Economics, City
University (A.M.), London, UK.
Correspondence to Dr Sara Lightowlers, Department of Geriatric Medicine, St Andrews's Hospital, Devas St, London E3 3NT, UK.
Background and Purpose—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 -£400.45 (ie, a resource saving achieved for each
life-year gained free from stroke) to £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.
© 1998 American Heart Association, Inc.
Original Contributions
Cost-Effectiveness of Anticoagulation in Nonrheumatic Atrial Fibrillation in the Primary Prevention of Ischemic Stroke
Key Words: atrial fibrillation • cost-benefit analysis • stroke
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