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Cost Effectiveness of Warfarin Versus Aspirin in Patients Older Than 75 Years With Atrial Fibrillation
Stroke, 04/25/2011
Clinical Article
Jowett S et al. – Warfarin is cost–effective compared with aspirin in atrial fibrillation patients age ≥75 years. These data support the anticoagulant therapy option in this high–risk patient population. However, the small differences in costs and effects indicate the importance of exploring patient preferences.
Methods- An economic evaluation was conducted alongside a randomized, controlled trial; 973 patients ≥75 years of age with atrial fibrillation were recruited from primary care and randomly assigned to either take warfarin or aspirin.
- Follow-up was for a mean of 2.7 years. Costs of thrombotic and hemorrhagic events, anticoagulation clinic visits, and primary care utilization were determined.
- Clinical benefits were expressed in terms of a primary event avoided: fatal/nonfatal disabling stroke, intracranial hemorrhage, or systemic embolism.
- A cost-utility analysis was performed using quality-adjusted life years as the benefit measure.
- Total costs over 4 years were lower in the warfarin group (difference, –£165; 95% CI, –£452–£89), primarily driven by the difference in primary event costs.
- The primary event rate over 4 years was lower in the warfarin group (0.049 versus 0.099), and the quality-adjusted life years score was higher (difference, 0.02; 95% CI, –0.07–0.11). With lower costs and a higher quality-adjusted life years score, warfarin is the dominant treatment, but the differences in both costs and effects are small.
