BACKGROUND: The most appropriate treatment(s) for @entity1 with @entity955 remains uncertain. OBJECTIVE: To examine the cost-effectiveness of anti- @entity715 and antiarrhythmic treatment strategies for @entity955 . METHODS: We performed decision and cost-effectiveness analyses using a Markov state transition model. We gathered data from the English-language literature using MEDLINE searches and bibliographies from selected articles. We obtained financial data from nationwide physician-fee references, a medical center's cost accounting system, and one of New England's larger managed care organizations. We examined strategies that included combinations of cardioversion, antiarrhythmic therapy with @entity5126 , @entity2778 , or @entity2643 , and anticoagulant or antiplatelet therapy. RESULTS: For a 65-year-old @entity1 with nonvalvular @entity955 , any intervention results in a significant gain in quality-adjusted life years (QALYs) compared with no specific therapy. Use of @entity117 results in the largest incremental gain (1.2 QALYs). Cardioversion followed by the use of @entity2643 and @entity1229 together is the most effective strategy, yielding a gain of 2.3 QALYs compared with no specific therapy. The marginal cost-effectiveness ratios of cardioversion followed by @entity117 , with or without @entity2643 , are  33800 per QALY and  10800 per QALY, respectively. Cardioversion followed by @entity2643 and @entity1229 has a marginal cost-effectiveness ratio of  92400 per QALY compared with @entity2643 and @entity117 . Strategies that include cardioversion followed by either @entity5126 or @entity2778 are both more expensive and less effective than competing strategies. CONCLUSIONS: Cardioversion of @entity1 with nonvalvular @entity955 followed by the use of @entity117 alone or with @entity2643 has a reasonable marginal cost-effectiveness ratio. While cardioversion followed by the use of @entity2643 and @entity1229 results in the greatest gain in quality-adjusted life expectancy, it is expensive (ie, has a high marginal cost-effectiveness ratio) compared with @entity117 and @entity2643 . Finally, for @entity1 who are bothered little by symptoms of @entity955 , cardioversion followed by either @entity117 or @entity1229 without subsequent antiarrhythmic therapy is the treatment of choice.

Cost-effectiveness of therapies for XXXX with nonvalvular @entity955 .

@entity1 :: ('9606', 'Species') :: ['patients', 'man'] @entity2643 :: ('MESH:D000638', 'Chemical') :: ['amiodarone'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity2778 :: ('MESH:D013015', 'Chemical') :: ['sotalol hydrochloride', 'sotalol'] @entity5126 :: ('MESH:D011802', 'Chemical') :: ['quinidine'] @entity955 :: ('MESH:D001281', 'Disease') :: ['atrial fibrillation'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombotic'] @entity1229 :: ('MESH:D014859', 'Chemical') :: ['warfarin']
@entity1 :: (9606,Species) :: ['patients']
