COST-EFFECTIVENESS OF PRIMARY STROKE PREVENTION IN ATRIAL-FIBRILLATION - SWEDISH NATIONAL PERSPECTIVE

Objective-To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population. Design-Analysis of cost effectiveness based on the following assumptions: about 83 000 people have atrial fibrillation in Sweden, of whom 22 000 would be potential candidates for treatment with anticoagulants and 55 000 for aspirin treatment; the annual 5% stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin); incidence of intracranial haemorrhage of 0.3%, 1.3%, or 2.0% per year; direct and indirect costs of a stroke of Kr180 000 and Kr90 000; estimated annual cost of treatment is Kr5030 for anticoagulants and Kr100 for aspirin. Setting-Total Swedish population. Main outcome measures-Direct and indirect costs of stroke saved, number of strokes prevented, and cost of preventive treatment. Results-Depending on the rate of haemorrhagic complications 34 to 83 patients would need to be treated annually with anticoagulants to prevent one stroke; 83 patients would need to be treated with aspirin. Giving anticoagulant treatment only would reduce costs by Kr60 million if the incidence of intracranial haemorrhage were 0.3% but would imply a net expense if the complication rate exceeded 1.3%. The total savings from giving anticoagulant (22 000 patients) and aspirin (55 000 patients) treatment would be Kr175 million per year corresponding to 2 million Pounds per million inhabitants each year. Conclusions-Treatment with anticoagulants and, if contraindications exist, with aspirin is cost effective provided that the risk of serious haemorrhage complications due to anticoagulants is kept low.