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A Health Economic Evaluation of Stroke Prevention in Atrial Fibrillation: Guideline Adherence Versus the Observed Treatment Strategy Prior to 2012 in Denmark

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Abstract

Background

In 2012 the European Society of Cardiology (ESC) published new guidelines on pharmacological stroke prophylaxis in non-valvular atrial fibrillation (AF). The health economics of adhering to these guidelines in clinical practice remains to be elucidated.

Objective

This paper offers a health economic evaluation of two stroke-prophylactic treatment strategies: complete national adherence to the ESC guidelines on stroke prophylaxis in AF versus stroke-prophylactic treatment prior to 2012 in Denmark.

Methods

A cost–utility analysis was performed to compare two treatment strategies. The first strategy reflected national guideline adherence with the use of non-vitamin K antagonist oral anticoagulants (i.e. dabigatran etexilate), warfarin, and no treatment. The second strategy reflected observed stroke prophylaxis prior to 2012 with the utilization of warfarin, acetylsalicylic acid, and no treatment. A Danish health sector perspective was adopted. A Markov model was designed and populated with information on input parameters from the literature and local cost data reflecting 2014 values. A modeled patient cohort was constructed with a risk profile intended to reflect that of the Danish patient population with AF. The applied outcome was quality-adjusted life-years (QALYs).

Results

The incremental cost-effectiveness ratio amounted to €3557 per QALY for the guideline-adherent treatment strategy (GTS) compared with the pre-2012 treatment strategy. This ratio is below a threshold of €25,000 (£20,000) per QALY. Sensitivity analyses revealed that the result was largely robust to changes in input parameters. All analyses found the GTS to be cost effective.

Conclusions

Guideline adherence is a cost-effective treatment strategy compared with the strategy employed prior to 2012 for pharmacological stroke prophylaxis in AF.

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Acknowledgments

The authors thank Torben Bjerregaard Larsen, MD, PhD, and Chief Physician at Aalborg University Hospital, for reviewing and commenting on the model structure and model inputs.

Conflicts of interest

No funding was received for the preparation of this study. Neither Anne Sig Vestergaard nor Lars Holger Ehlers report any conflicts of interest.

Author contributions

Conceptualization of the study, interpretation of results, and revisions of the manuscript were performed in cooperation between Anne Sig Vestergaard and Lars Holger Ehlers. Anne Sig Vestergaard performed the modeling, had primary responsibility for input parameter identification, and drafted the paper. Lars Holger Ehlers supervised the project and critically revised the manuscript for important intellectual content. Anne Sig Vestergaard acts as the overall guarantor for the content of this article.

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  1. Danish Center for Healthcare Improvements, Aalborg University, Fibigerstræde 11, 9220, Aalborg Øst, Denmark

    Anne Sig Vestergaard & Lars Holger Ehlers

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  1. Anne Sig Vestergaard
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Correspondence to Anne Sig Vestergaard.

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Vestergaard, A.S., Ehlers, L.H. A Health Economic Evaluation of Stroke Prevention in Atrial Fibrillation: Guideline Adherence Versus the Observed Treatment Strategy Prior to 2012 in Denmark. PharmacoEconomics 33, 967–979 (2015). https://doi.org/10.1007/s40273-015-0281-z

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