Factors determining utility measured with the EQ-5D in patients with atrial fibrillation.

PURPOSE: Although atrial fibrillation (AF) is associated with increased morbidity and mortality from heart failure, stroke and other thromboembolic complications, there are limited data on its health-related quality of life (HRQoL) effects. The objective was to analyse the factors determining utility in patients with all types of AF, both at baseline and after 1 year from inclusion, based on data from the Euro heart survey. METHODS: HRQoL was measured with the EQ-5D questionnaire. At baseline, 5,050 patients had completed all five dimensions of the EQ-5D and 3,045 had done so after 1 year. We used Powell's censored least absolute deviations estimator for inference and ordinary least squares regressions for prediction. RESULTS: Regardless of time point, utility and change in utility were significantly correlated with age, gender, AF type and symptoms. At baseline, utility was also determined by domestic status, regular exercise habits, diabetic disease and comorbidities. At follow-up, additional determinants included underlying heart disease and utility at baseline, and adverse events. CONCLUSION: Utility in patients with AF and change over time are influenced by demographic and disease-specific variables. Our results can provide useful information on the effect of AF on QoL and input for economic evaluations.

Long-term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention results: from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial.

OBJECTIVES: This study sought to evaluate the long-term cost effectiveness of a clopidogrel loading strategy before percutaneous coronary intervention (PCI) followed by continued treatment for one year. BACKGROUND: The Clopidogrel for the Reduction of Events During Observation (CREDO) trial, a randomized trial of 2,116 patients, showed the effectiveness of antiplatelet therapy with clopidogrel 300 mg before PCI and 75 mg daily for one year afterward compared with placebo load and placebo days 29 to 365 in reducing the combined risk of death, myocardial infarction, and stroke. All patients received clopidogrel on days 1 to 28 and aspirin on days 1 to 365. METHODS: All hospitalizations were assigned a diagnosis-related group. Associated costs were estimated three ways (including professional costs): 1) Medicare costs, 2) MEDSTAT costs, and 3) blend with Medicare for those age > or = 65 years and MEDSTAT for those age <65 years. Clopidogrel 75 mg cost 3.22 dollars. Life expectancy in trial survivors was estimated using external data. Confidence intervals were assessed by bootstrap. RESULTS: The primary composite end point occurred in 89 (8.45%) clopidogrel patients and in 122 (11.48%) placebo patients (relative risk reduction [RRR] 26.9%; 95% confidence interval [CI] 3.9% to 44.4%). The number of life-years gained (LYG) with clopidogrel was 0.1526 (95% CI 0.0263 to 0.2838) using Framingham data and 0.1920 (95% CI 0.054 to 0.337) using Saskatchewan data. Average total costs were 664 dollars higher for the clopidogrel arm (95% CI -461 dollars to 1,784 dollars). The incremental cost-effectiveness ratios (ICERs) based on Framingham data ranged from 3,685 dollars/LYG to 4,353 dollars/LYG, with over 97% of bootstrap-derived ICER estimates below 50,000 dollars/LYG. The ICERs based on Saskatchewan data were 2,929 dollars/LYG to 3,460 dollars/LYG, with over 98% of estimates below 50,000 dollars/LYG. CONCLUSIONS: Platelet inhibition with clopidogrel loading before PCI followed by therapy for one year is highly cost effective.