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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Cost-Effectiveness of Bridging Anticoagulation Among Patients with Nonvalvular Atrial Fibrillation

Matthew A Pappas1,2, Geoffrey D Barnes3, Sandeep Vijan4

  • 1Center for Value-Based Care Research, Medicine Institute , Cleveland Clinic, Cleveland, OH, USA. pappasm@ccf.org.

Journal of General Internal Medicine
|January 10, 2019
PubMed

Insights

Bridging anticoagulation for atrial fibrillation patients may cause harm. Careful patient selection for outpatient bridging can be beneficial and cost-effective, avoiding hospital admission.

Area of Science:

  • Cardiology
  • Pharmacoeconomics
  • Health Policy

Background:

  • Bridging anticoagulation is frequently used for atrial fibrillation patients undergoing warfarin therapy.
  • Current guidelines suggest bridging for high-stroke-risk patients, but recent trials indicate potential harm in lower-risk groups.
  • Evidence for selecting patients who benefit from bridging based on both stroke and bleeding risks is limited.

Purpose of the Study:

  • To assess the utility and cost-effectiveness of bridging anticoagulation in nonvalvular atrial fibrillation patients.
  • Stratify analysis by individual thromboembolic and hemorrhagic risks.
  • Inform optimal patient selection for bridging therapy.

Main Methods:

  • Cost-effectiveness analysis with a lifelong time horizon.
  • Utilized quality-adjusted life years (QALYs) and cost per QALY gained.
  • Modeled outcomes from a third-party payer perspective.

Main Results:

  • Unselected nonvalvular atrial fibrillation patients may experience harm from bridging anticoagulation.
  • Hospital admission for bridging is rarely cost-effective and generally detrimental.
  • Outpatient bridging demonstrates benefit and cost-effectiveness in carefully selected patients with low bleeding and high thromboembolic risk.

Conclusions:

  • Outpatient bridging anticoagulation offers benefits and cost-effectiveness for specific nonvalvular atrial fibrillation patients during warfarin management.
  • Hospital admission for bridging should be avoided due to potential harm and poor cost-effectiveness.
Abstract

Keywords:
Monte Carlo methodanticoagulantsatrial fibrillationmodels, statisticalthromboembolism

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