Key result
A Markov decision-analytic model for elderly patients with CNVAF estimated 5-year quality-adjusted survival for 70-year-old males at 4.03 QALYs on warfarin, 4.02 on aspirin, and 3.95 on no treatment.
Why the study?
Does warfarin or aspirin improve 5-year QALYs compared to no treatment in elderly patients with chronic nonvalvular atrial fibrillation?
Does warfarin or aspirin improve 5-year QALYs compared to no treatment in elderly patients with chronic nonvalvular atrial fibrillation?
In a decision-analytic model of elderly patients with CNVAF, warfarin and aspirin yielded similar 5-year QALYs, with the optimal strategy depending heavily on patient-specific disutility for warfarin and assumed aspirin effectiveness.
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Marginal QALY gains with antithrombotics support individualized decisions; leaves open optimal strategy in elderly CNVAF pending validation.
The objective of the study was to determine the preferred treatment strategy for elderly patients with chronic nonvalvular atrial fibrillation (CNVAF). A Markov decision-analytic model was used to compare three treatment strategies for CNVAF: 1) warfarin; 2) aspirin; and 3) no treatment. Five-year quality-adjusted life years (QALYs) were calculated for male and female cohorts aged 70 and 75 years. In the baseline analysis (effectiveness of warfarin = 0.70, effectiveness of aspirin = 0.45, utility of warfarin = 0.99, and utility of aspirin = 0.999) the quality-adjusted survival rates for 70-year-old males were 4.03 QALYs on warfarin, 4.02 QALYs on aspirin, and 3.95 QALYs on no treatment. Results were similar for all age and sex cohorts. Sensitivity analyses revealed that the results were very sensitive to the effectiveness of aspirin and the disutility of warfarin. The authors conclude that the optimal strategy for the treatment of CNVAF in elderly patients varies with the disutility assigned to warfarin therapy and the effectiveness value for aspirin therapy.
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Naglie et al. (1992) studied chronic nonvalvular atrial fibrillation. warfarin vs. aspirin and no treatment was evaluated on Five-year quality-adjusted life years (QALYs). A Markov decision-analytic model for elderly patients with CNVAF estimated 5-year quality-adjusted survival for 70-year-old males at 4.03 QALYs on warfarin, 4.02 on aspirin, and 3.95 on no treatment.
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