The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .
Cost-effectiveness of warfarin: trial versus "real-world" stroke prevention in atrial fibrillation.
BACKGROUND AND PURPOSE Previous cost-effectiveness analyses analyzed warfarin for stroke prevention in r and omized trial setting s. Given the complexities of warfarin treatment , cost-effectiveness should be examined within a real-world setting . METHODS Our model followed patients with atrial fibrillation at moderate to high risk of stroke through primary and recurrent ischemic stroke , hemorrhages -- intracranial and extracranial , and the result ing disability . Four scenarios were examined : ( 1 ) all patients start on warfarin with perfect control , that is , international normalized ratio ( INR ) values always within range ; ( 2 ) all patients start on warfarin with trial-like control , where INR can fall outside the recommended range ; ( 3 ) all patients start on warfarin with real-world INR control ; and ( 4 ) real-world prescription ( and control ) of warfarin , aspirin , or neither for warfarin-eligible patients . Reported warfarin discontinuation rates were used . Main outcomes were total number of events , quality adjusted life years , and costs in a US setting . RESULTS The total number of primary and recurrent ischemic strokes in a 1,000-patient cohort ( age 70 years , lifetime analysis ) was 626 , 832 , 984 , and 1,171 in scenarios 1 to 4 , respectively . The corresponding mean quality adjusted life years per patient were 7.21 , 6.92 , 6.75 , and 6.67 for scenarios 1 to 4 , respectively . Costs per patient were $ 68,039 , $ 77,764 , $ 84,518 , and $ 87,248 in scenarios 1 to 4 , respectively . If " perfect " adherence to warfarin was assumed , except for discontinuations for clinical reasons , strokes would decrease to 503 , 737 , 909 , and 1,120 in scenarios 1 to 4 , respectively . CONCLUSIONS Clinical and cost outcomes are strongly dependent on the quality of anticoagulation and rates of warfarin discontinuation . Clinicians should work to improve both . Policy makers should use real-world INR control and warfarin discontinuation rates when assessing cost-effectiveness
The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .