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 10 784 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.