Costs and effects of long-term oral anticoagulant treatment after myocardial infarction

Objective. —To investigate the costs and effects of long-term oral anticoagulant treatment after myocardial infarction. Design. —Cost-effectiveness analysis, based on a randomized, double-blind, placebo-controlled trial. Setting. —Sixty Dutch hospitals. Patients. —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. Intervention. —Oral anticoagulant treatment aimed at a target international normalized ratio of 2.8 to 4.8. Main Outcome Measurements. —Costs of hospital stay during readmissions, costs related to major cardiologic interventions, and costs of oral anticoagulant treatment. Results. —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. Conclusions. —Costs of long-term anticoagulant treatment are outweighed by the costs of prevented clinical events. (JAMA. 1995;273:925-928)