Costs and Effects of Long-term Oral Anticoagulant Treatment After Myocardial Infarction

Abstract

<h3>Objective.</h3> —To investigate the costs and effects of long-term oral anticoagulant treatment after myocardial infarction. <h3>Design.</h3> —Cost-effectiveness analysis, based on a randomized, double-blind, placebo-controlled trial. <h3>Setting.</h3> —Sixty Dutch hospitals. <h3>Patients.</h3> —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. <h3>Intervention.</h3> —Oral anticoagulant treatment aimed at a target international normalized ratio of 2.8 to 4.8. <h3>Main Outcome Measurements.</h3> —Costs of hospital stay during readmissions, costs related to major cardiologic interventions, and costs of oral anticoagulant treatment. <h3>Results.</h3> —The costs of oral anticoagulant treatment were estimated at 394 Dutch guilders (Dfl) per patient-year (Dfl1=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 10784 for placebo patients and Dfl 9878 for anticoagulation patients. <h3>Conclusions.</h3> —Costs of long-term anticoagulant treatment are outweighed by the costs of prevented clinical events. (<i>JAMA</i>. 1995;273:925-928)