Jb. Oostenbrink et al., Cost-effectiveness of oral anticoagulants versus aspirin in patients afterinfrainguinal bypass grafting surgery, J VASC SURG, 34(2), 2001, pp. 254-262
Citations number
17
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Purpose. Several antithrombotic therapies are available for the treatment o
f patients with peripheral vascular diseases. It is unknown how quality of
life and costs of treatment are influenced by different therapies. This stu
dy assessed the cost-effectiveness of oral anticoagulants versus aspirin in
patients after infrainguinal bypass grafting surgery. Methods: Clinical ou
tcome events and event-free survival were collected from 2650 patients in 7
7 centers who participated in the Dutch Bypass Oral anticoagulants or Aspir
in trial. Approximately half the patients had critical ischemia; 60% receiv
ed vein grafts, and 20% had femorocrural bypass grafts. A model that was pr
imarily driven by clinical outcome events was used as a means of determinin
g quality of life (EuroQol EQ-5D) and costs for each patient. The main outc
ome measure was the incremental health care costs in relation to the additi
onal number of quality-adjusted life years and the additional number of eve
nt-free years.
Results: The mean costs during the 21 months of follow-up were 6875 per pat
ient in the oral anticoagulants group versus 7072 in the aspirin group (dif
ference, 197; 95% CI, -746 to 343). The event-free survival was 1.10 years
in the group treated with oral anticoagulants versus 1.09 years in the grou
p treated with aspirin (difference, 0.01; 95% CI, -0.07 to 0.08), whereas t
he corresponding quality-adjusted life years were 1.06 and 1.05, respective
ly (difference, 0.01; 95% CI, -0.03 to 0.06).
Conclusion: Health care costs, event-free survival, and quality-adjusted li
fe years in patients after infrainguinal bypass surgery were not different
in patients treated with aspirin and patients treated with oral anticoagula
nts. The extra costs of monitoring patients treated with oral anticoagulaut
s were limited and play no role in the decision for treatment.