Common flaws exist in published cost-effectiveness models of pharmacologic stroke prevention in atrial fibrillation |
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Affiliation: | 1. Evidence-Based Practice Center, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA;2. University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT 06102, USA;3. Department of Cardiology, Hartford Hospital, Hartford, CT 06102, USA |
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Abstract: | ObjectivesDecision makers use models to assist in evaluating the cost-effectiveness of pharmacologic stroke prevention in atrial fibrillation (SPAF).Study Design and SettingWe performed a search of databases through October 3, 2012 to identify pharmacologic SPAF cost-effectiveness models.ResultsOf 30 identified models, 28 included warfarin, but only 60% assessed the impact of warfarin control on conclusions. Aspirin, dual antiplatelet, and newer anticoagulants were included in 41%, 10%, and 63% of models, respectively. Models used similar structures but included varying health states and made varying assumptions. They rarely reported performing a literature search to identify anticoagulant-specific inputs and used similar and older sources. Sixteen models used a lone randomized trial to reflect the efficacy and safety of main comparisons. One-third of models claimed a societal perspective; however, none included indirect costs. Patients typically initiated anticoagulation in the sixth or seventh decade of life and are followed for their lifetimes. Almost 70% of incremental cost-effectiveness ratios were below reported willingness-to-pay thresholds. All used deterministic sensitivity analyses and 77% conducted Monte Carlo simulation. Less than half of the models were rated “high quality,” yet were frequently published in high-impact journals.ConclusionPharmacologic SPAF cost-effectiveness models have been extensively reported, but many may have flaws giving reason for decision makers to use caution. We provide 10 recommendations to avoid common flaws in SPAF cost-effectiveness models. |
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Keywords: | Atrial fibrillation Anticoagulants Decision modeling Markov model Cost effectiveness Economics Medical |
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