This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Thrombolysis  • Neurology  • Cerebrovascular Disease  • Stroke  • Cardiovascular System  • Arrhythmias  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: We would like to raise concerns about a possible bias in the cost-effectiveness analysis by Drs O’Brien and Gage.¹ To calculate quality-adjusted survival, the authors used results of a previous survey of 83 patients with atrial fibrillation,² which estimated the mean utility of warfarin therapy to be 0.987 and the mean utility of aspirin therapy to be 0.998. We believe that the utility of warfarin therapy may be overestimated.

Gage et al noted in the previous study² that 11 of 70 patients rated the utility of warfarin therapy so low that their quality-adjusted life expectancy would be greater with aspirin, and there was great interpatient variability. In the present study, sensitivity analyses were conducted across a range of only 0.953 to 1.0 for warfarin, while in the cited study these utilities varied from 0.5 to 1.0. Moreover, in another decision analysis of anticoagulant therapy for prevention . . . [Full Text of this Article]

Christine Perret-Guillaume, MD
c.perret-guillaume@chu-nancy.fr
Department of Internal Medicine
Unit of Geriatrics and Internal Medicine
Centre Hospitalier Universitaire Nancy
Nancy, France

Denis Wahl, MD, PhD
INSERM Unite 734
Université Poincaré Nancy I
Nancy, France

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Cost-effectiveness of Ximelagatran for Stroke Prevention--Reply
and
JAMA. ;293():2861-2861.
FULL TEXT  

Costs and Effectiveness of Ximelagatran for Stroke Prophylaxis in Chronic Atrial Fibrillation
and
JAMA. ;293():699-706.
FULL TEXT