Atrial fibrillation: Cost-effectiveness and Decision analysis studies
DISEASE INTERVENTION COMPARISON RESULTS
Ann Intern Med 1999 Apr 20;130(8):625-36 Cost-Effectiveness
IN atrial fibrillation The Use of
cardioversion alone followed by repeated cardioversion plus amiodarone therapy on relapse
As Treatment, Chronic
Is better Than
cardioversion alone followed by warfarin therapy on relapse
To gain expected costs per quality-adjusted life-year (QALY). In the lowest-risk of stroke cohort, cardioversion alone followed by aspirin therapy on relapse was optimal.
Arch Intern Med 1998 Aug 10-24;158(15):1669-77 Cost-Effectiveness
IN atrial fibrillation The Use of
cardioversion followed by the use of aspirin alone or with amiodarone
As Treatment, Chronic
Is better Than
cardioversion followed by the use of amiodarone and warfarin
To gain expected costs per quality-adjusted life-year (QALY), but marginally, and cardioversion followed by amiodarone and warfarin resulted in the greatest gain in QALYs
Value Health. 2000 Nov-Dec;3(6):407-16 Cost-Effectiveness
IN atrial fibrillation, cost The Use of
different treatment with drugs
As Treatment, Chronic
Is equal Than
each other
To reduce cost: no strategy was better. AF has high demands on medical resources, mainly because its complications and comorbidity.
Arch Intern Med. 1999 Apr 12;159(7):677-85 Decision Model
IN atrial fibrillation, elderly patients The Use of
warfarin
As Treatment, Chronic
Is better Than
aspirin or no treatment
To increase, in patients with average risk of stroke, expected QALYs: 12.9 warfarin, 11.2 aspirin and 10.15 no Tt.
J Am Geriatr Soc. 2002 May;50(5):863-9 Decision Model
IN atrial fibrillation, elderly patients The Use of
warfarin, anticoagulants
As Treatment, Chronic
Is equal Than
aspirin or no treatment
To increase expected QALYs: no compelling evidence of gain in quality-adjusted life expectancy with anticoagulation.
Lancet. 2000 Mar 18;355(9208):956-62 Decision Model
IN atrial fibrillation, embolic complications The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin or placebo
To reduce stroke and parterial embolism for most patients, specially those older
J Am Coll Cardiol. 2006 Jun 20;47(12):2513-20 Cost-Effectiveness
IN atrial fibrillation, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Chronic
Is better Than
other treatment strategies
To increase QALY at acceptable costs: ablation can be cost-effective in patients with moderate to high risk of stroke, but not at low risk.
Ann Intern Med. 1994 Mar 15;120(6):449-57 Decision Model
IN atrial fibrillation, persistent The Use of
rhythm control using amiodarone
As Treatment, Chronic
Is better Than
some other strategies: no treatment, warfarin alone, rhythm control using quinidine
To gain more quality-adjusted life-years: amiodarone obtained the best value (4.75 years), followed by warfarin (4.72 years), quinidine (4.68 years), and no treatment (4.55 years).
Ann Intern Med. 2004 Nov 2;141(9):653-61 Cost-Effectiveness
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To improve cost-effectiveness: rate control is always more effective and less costly