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Cost Effectiveness of different treatment strategies for Non-valvular Atrial Fibrillation in patients after Intracerebral Hemorrhage

Olde Keizer, I.E.H. (2018) Cost Effectiveness of different treatment strategies for Non-valvular Atrial Fibrillation in patients after Intracerebral Hemorrhage.

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Abstract:Background- Patients who survive an intracerebral hemorrhage (ICH) and suffer from non-valvular atrial fibrillation (NVAF) have an increased risk of both ischemic stroke and recurrent ICH. Currently there are different treatment options for these patients; vitamin K antagonists (VKA), non-vitamin K anticoagulation (NOAC), left atrial appendage occlusion (LAAO) or no treatment at all. We determined the most cost-effective option. Methods- We used a Markov model to evaluate quality of adjusted life years (QALY), additional costs and the incremental cost effectiveness ratio (ICER) of VKAs, NOACs and LAAO in comparison with no treatment, separately for 14 risk groups. The risk groups are independent of the treatment option and were classified based on the CHA2DS2 VASC (low, medium, high risk of ischemic stroke) and the HAS-BLED (low, medium, high risk of ICH) score. Also location of the previous ICH was taken into account (lobar vs non-lobar), since lobar ICH has a higher recurrence rate. Results- All treatment options resulted in health gain: in the base case no treatment resulted in 4.2 QALYs, VKA in 7.0 QALYs, NOAC in 7.4 QALYs and LAAO in 8.4 QALYs gained. NOAC was slightly more favorable than VKA treatment, in terms of cost-effectiveness. But every risk group LAAO was the most cost-effective treatment. In the risk group with lowest expected risks (Ischemic stroke low, ICH low, non-lobar) the ICER of LAAO was 31,878 €/QALY, compared to no treatment. In the risk group with highest expected risks (Ischemic stroke high, ICH high, lobar) the ICER was 31,785 €/QALY, compared to no treatment. The ICER of LAAO increases with expected risk until the ischemic stroke medium, ICH medium, non-lobar risk group with an ICER of 33,641 €/QALY. Conclusion- LAAO is the most cost effective treatment in NVAF patients who survive ICH and results in most QALYs gained.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:70 social sciences in general
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/76244
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