Costs and effects of long-term oral anticoagulant treatment after myocardial infarction
P. F. van Bergen, J. J. Jonker, B. A. van Hout, R. T. van Domburg, J. W. Deckers, A. J. Azar and A. Hofman
ASPECT Coordinating Centre, Rotterdam, The Netherlands.
OBJECTIVE--To investigate the costs and effects of long-term oral
anticoagulant treatment after myocardial infarction.
DESIGN--Cost-effectiveness analysis, based on a randomized, double-blind,
placebo-controlled trial. SETTING--Sixty Dutch hospitals. PATIENTS--A total
of 3404 hospital survivors of acute myocardial infarction randomized within
a median period of 4 days after discharge to either oral anticoagulant
treatment or placebo. The mean follow-up was 37 months. INTERVENTION--Oral
anticoagulant treatment aimed at a target international normalized ratio of
2.8 to 4.8. MAIN OUTCOME MEASUREMENTS--Costs of hospital stay during
readmissions, costs related to major cardiologic interventions, and costs
of oral anticoagulant treatment. RESULTS--The costs of oral anticoagulant
treatment were estimated at 394 Dutch guilders (Dfl) per patient-year (Dfl
1 = US $0.58). Placebo patients stayed 18,830 days in the hospital compared
with 15,083 days for anticoagulation patients. Average costs per patient of
medical care during follow-up were estimated at Dfl 10,784 for placebo
patients and Dfl 9878 for anticoagulation patients. CONCLUSIONS--Costs of
long-term anticoagulant treatment are outweighed by the costs of prevented
clinical events.
