No 1197
Study Quality:1+A cost-effectiveness analysis of aspirin versus oral anticoagulants after acute myocardial infarction in Italy: equivalence of costs as a possible case for oral anticoagulants
Author:Gianetti J; Gensini G; De CR; 1998
Population:Patients having had an acute myocardial infarction
PerspectiveNHS, Italy
StudyCEA, re-infarction, PCTA, CABG, major bleeding, cerebrovascular events, AV Thromboembolism
Methods:RCT ASPECT study, APT collaboration
Health valuations:NOT APPLICABLE
Cost components:Direct medical and treatment costs. Costs were derived from literature and DRGs Treatment costs were estimated for two DRG pricing schemes: the mean price and the daily price multiplied by mean length of stay
Currency:OTHER (Italian Lira) and European currency
Time horizon:3 years
Discount rate:no discounting was done
Results Cost/patient:The total cost of therapy per patient/year, was ECU277.56 (warfarin) and ECU62.53 (aspirin).The cost of morbidity per patient per year, using DRG mean total costs, was ECU1, 873.32 (warfarin) and ECU2,125.4 (aspirin). The cost of morbidity per patient per year, using the product of DRG mean cost per day and mean length of stay, was ECU1,848.06 (warfarin) and ECU2, 074.01 (aspirin)
Results Effectiveness:Results are presented graphically as aspirin/warfarin efficacy ratio. This was found to be close to 0.68
Results Incremental:Results were not synthesized therefore it was a cost minimisation analysis. The total cost per patient per year, using DRG mean total costs, was ECU2, 150.8 or $2,731.4 (warfarin), and ECU2,187.9 or $2,778.9 (aspirin). The total cost per patient per year, using the product of DRG mean cost per day and mean length of stay, was ECU2,125.2 or $2,699.0 (warfarin), and ECU2,136.6 or $2,713.9 (aspirin).
Results Uncertainty:Two way sensitivity analyses was done on the efficacy of warfarin/aspirin and the cumulative costs of both drugs. Results were sensitive to variations in the aspirin-warfarin efficacy ratio. Warfarin is no longer the cost-effective strategy in Italy once an efficacy ratio of approximately
Source Funding:not stated
Comments:The study was well reported but had some weaknesses which were identified. The authors reported aspirin-warfarin efficacy ratio of about 0.68 which was based on indirect comparisons. This showed that warfarin was as cheap and effective as aspirin. Recent data WARIS 11 has shown an efficacy ratio of 0.81. Using this recent data it would appear cumulative costs of Aspirin are cheaper than those of Warfarin. The study did not report on the true variability of cost items and only an arbitrary value of 5% was imposed.

From: Appendix D, Health Economic Extractions

Cover of Post Myocardial Infarction
Post Myocardial Infarction: Secondary Prevention in Primary and Secondary Care for Patients Following a Myocardial Infarction [Internet].
NICE Clinical Guidelines, No. 48.
National Collaborating Centre for Primary Care (UK).
Copyright © 2007, National Collaborating Centre for Primary Care.

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