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Patients on vitamin K treatment: is switching to direct-acting oral anticoagulation cost-effective? A target trial on a prospective cohort.
Aebersold, Helena; Foster-Witassek, Fabienne; Aeschbacher, Stefanie; Beer, Juerg H; Blozik, Eva; Blum, Manuel; Bonati, Leo; Conte, Giulio; Coslovsky, Michael; De Perna, Maria Luisa; Di Valentino, Marcello; Felder, Stefan; Huber, Carola A; Moschovitis, Giorgio; Mueller, Andreas; Paladini, Rebecca E; Reichlin, Tobias; Rodondi, Nicolas; Stauber, Annina; Sticherling, Christian; Szucs, Thomas D; Conen, David; Kuhne, Michael; Osswald, Stefan; Schwenkglenks, Matthias; Serra-Burriel, Miquel.
Afiliación
  • Aebersold H; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland helena.aebersold@uzh.ch.
  • Foster-Witassek F; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
  • Aeschbacher S; Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
  • Beer JH; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
  • Blozik E; Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
  • Blum M; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.
  • Bonati L; Institute of Primary Care, University of Zurich, Zurich, Switzerland.
  • Conte G; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
  • Coslovsky M; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • De Perna ML; Department of Neurology, University Hospital Basel, Basel, Switzerland.
  • Di Valentino M; Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
  • Felder S; Division of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland.
  • Huber CA; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
  • Moschovitis G; Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
  • Mueller A; Division of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland.
  • Paladini RE; Division of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland.
  • Reichlin T; Faculty of Business and Economics, University of Basel, Basel, Switzerland.
  • Rodondi N; Department of Health Sciences, Helsana Group, Zurich, Switzerland.
  • Stauber A; Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Istituto Cardiocentro Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.
  • Sticherling C; Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
  • Szucs TD; Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
  • Conen D; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
  • Kuhne M; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Osswald S; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
  • Schwenkglenks M; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Serra-Burriel M; Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
Open Heart ; 11(1)2024 Jan 31.
Article en En | MEDLINE | ID: mdl-38302139
ABSTRACT

AIMS:

Direct-acting oral anticoagulants (DOACs) have, to a substantial degree, replaced vitamin K antagonists (VKA) as treatments for stroke prevention in atrial fibrillation (AF) patients. However, evidence on the real-world causal effects of switching patients from VKA to DOAC is lacking. We aimed to assess the empirical incremental cost-effectiveness of switching patients to DOAC compared with maintaining VKA treatment.

METHODS:

The target trial approach was applied to the prospective observational Swiss-AF cohort, which enrolled 2415 AF patients from 2014 to 2017. Clinical data, healthcare resource utilisation and EQ-5D-based utilities representing quality of life were collected in yearly follow-ups. Health insurance claims were available for 1024 patients (42.4%). Overall survival, quality-of-life, costs from the Swiss statutory health insurance perspective and cost-effectiveness were estimated by emulating a target trial in which patients were randomly assigned to switch to DOAC or maintain VKA treatment.

RESULTS:

228 patients switching from VKA to DOAC compared with 563 patients maintaining VKA treatment had no overall survival advantage over a 5-year observation period (HR 0.99, 95% CI 0.45, 1.55). The estimated gain in quality-adjusted life years (QALYs) was 0.003 over the 5-year period at an incremental costs of CHF 23 033 (€ 20 940). The estimated incremental cost-effectiveness ratio was CHF 425 852 (€ 387 138) per QALY gained.

CONCLUSIONS:

Applying a causal inference method to real-world data, we could not demonstrate switching to DOACs to be cost-effective for AF patients with at least 1 year of VKA treatment. Our estimates align with results from a previous randomised trial.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 Problema de salud: 1_doencas_nao_transmissiveis / 1_financiamento_saude / 2_muertes_prematuras_enfermedades_notrasmisibles Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Observational_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 Problema de salud: 1_doencas_nao_transmissiveis / 1_financiamento_saude / 2_muertes_prematuras_enfermedades_notrasmisibles Asunto principal: Fibrilación Atrial / Accidente Cerebrovascular Tipo de estudio: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Observational_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Humans Idioma: En Revista: Open Heart Año: 2024 Tipo del documento: Article País de afiliación: Suiza
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