PURPOSE: Several antithrombotic therapies are available for the treatment of patients with peripheral vascular diseases. It is unknown how quality of life and costs of treatment are influenced by different therapies. This study assessed the cost-effectiveness of oral anticoagulants versus aspirin in patients after infrainguinal bypass grafting surgery. METHODS:Clinical outcome events and event-free survival were collected from 2650 patients in 77 centers who participated in the Dutch Bypass Oral anticoagulants or Aspirin trial. Approximately half the patients had critical ischemia; 60% received vein grafts, and 20% had femorocrural bypass grafts. A model that was primarily driven by clinical outcome events was used as a means of determining quality of life (EuroQol EQ-5D) and costs for each patient. The main outcome measure was the incremental health care costs in relation to the additional number of quality-adjusted life years and the additional number of event-free years. RESULTS: The mean costs during the 21 months of follow-up were epsilon 6875 per patient in the oral anticoagulants group versus epsilon 7072 in the aspirin group (difference, 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 group treated with aspirin (difference, 0.01; 95% CI, -0.07 to 0.08), whereas the corresponding quality-adjusted life years were 1.06 and 1.05, respectively (difference, 0.01; 95% CI, -0.03 to 0.06). CONCLUSION:Health care costs, event-free survival, and quality-adjusted life years in patients after infrainguinal bypass surgery were not different in patients treated with aspirin and patients treated with oral anticoagulants. The extra costs of monitoring patients treated with oral anticoagulants were limited and play no role in the decision for treatment.
RCT Entities:
PURPOSE: Several antithrombotic therapies are available for the treatment of patients with peripheral vascular diseases. It is unknown how quality of life and costs of treatment are influenced by different therapies. This study assessed the cost-effectiveness of oral anticoagulants versus aspirin in patients after infrainguinal bypass grafting surgery. METHODS: Clinical outcome events and event-free survival were collected from 2650 patients in 77 centers who participated in the Dutch Bypass Oral anticoagulants or Aspirin trial. Approximately half the patients had critical ischemia; 60% received vein grafts, and 20% had femorocrural bypass grafts. A model that was primarily driven by clinical outcome events was used as a means of determining quality of life (EuroQol EQ-5D) and costs for each patient. The main outcome measure was the incremental health care costs in relation to the additional number of quality-adjusted life years and the additional number of event-free years. RESULTS: The mean costs during the 21 months of follow-up were epsilon 6875 per patient in the oral anticoagulants group versus epsilon 7072 in the aspirin group (difference, 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 group treated with aspirin (difference, 0.01; 95% CI, -0.07 to 0.08), whereas the corresponding quality-adjusted life years were 1.06 and 1.05, respectively (difference, 0.01; 95% CI, -0.03 to 0.06). CONCLUSION: Health care costs, event-free survival, and quality-adjusted life years in patients after infrainguinal bypass surgery were not different in patients treated with aspirin and patients treated with oral anticoagulants. The extra costs of monitoring patients treated with oral anticoagulants were limited and play no role in the decision for treatment.
Authors: Jarir Atthobari; Jasper M Bos; Cornelis Boersma; Jacobus R B J Brouwers; Lolkje T W de Jong-van den Berg; Maarten J Postma Journal: Pharm World Sci Date: 2005-10
Authors: Lori Mosca; Emelia J Benjamin; Kathy Berra; Judy L Bezanson; Rowena J Dolor; Donald M Lloyd-Jones; L Kristin Newby; Ileana L Piña; Véronique L Roger; Leslee J Shaw; Dong Zhao; Theresa M Beckie; Cheryl Bushnell; Jeanine D'Armiento; Penny M Kris-Etherton; Jing Fang; Theodore G Ganiats; Antoinette S Gomes; Clarisa R Gracia; Constance K Haan; Elizabeth A Jackson; Debra R Judelson; Ellie Kelepouris; Carl J Lavie; Anne Moore; Nancy A Nussmeier; Elizabeth Ofili; Suzanne Oparil; Pamela Ouyang; Vivian W Pinn; Katherine Sherif; Sidney C Smith; George Sopko; Nisha Chandra-Strobos; Elaine M Urbina; Viola Vaccarino; Nanette K Wenger Journal: J Am Coll Cardiol Date: 2011-03-22 Impact factor: 24.094
Authors: Lori Mosca; Emelia J Benjamin; Kathy Berra; Judy L Bezanson; Rowena J Dolor; Donald M Lloyd-Jones; L Kristin Newby; Ileana L Piña; Véronique L Roger; Leslee J Shaw; Dong Zhao; Theresa M Beckie; Cheryl Bushnell; Jeanine D'Armiento; Penny M Kris-Etherton; Jing Fang; Theodore G Ganiats; Antoinette S Gomes; Clarisa R Gracia; Constance K Haan; Elizabeth A Jackson; Debra R Judelson; Ellie Kelepouris; Carl J Lavie; Anne Moore; Nancy A Nussmeier; Elizabeth Ofili; Suzanne Oparil; Pamela Ouyang; Vivian W Pinn; Katherine Sherif; Sidney C Smith; George Sopko; Nisha Chandra-Strobos; Elaine M Urbina; Viola Vaccarino; Nanette K Wenger Journal: Circulation Date: 2011-02-14 Impact factor: 29.690
Authors: Anil Vaidya; Manuela A Joore; Arina J Ten Cate-Hoek; Hugo Ten Cate; Johan L Severens Journal: BMC Public Health Date: 2014-01-29 Impact factor: 3.295