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• W2071449669 endingPage "635" @default.
• W2071449669 startingPage "625" @default.
• W2071449669 abstract "The optimal duration and intensity of warfarin therapy after a first idiopathic venous thromboembolic event are uncertain. We used decision analysis to evaluate clinical and economic outcomes of different anticoagulation strategies with warfarin.We built a Markov model to assess 6 strategies to treat 40- to 80-year-old men and women after their first idiopathic venous thromboembolic event: 3-month, 6-month, 12-month, 24-month, and unlimited-duration conventional-intensity anticoagulation (International Normalized Ratio, 2-3) and unlimited-duration low-intensity anticoagulation (International Normalized Ratio, 1.5-2). The model incorporated age- and sex-specific clinical parameters, utilities, and costs. Using a societal perspective, we compared strategies based on quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios.In our baseline analysis, incremental cost-effectiveness ratios were lower in younger patients and in men, reflecting the higher bleeding risk at older ages, and the lower risk of recurrence among women. Based on a willingness-to-pay of <$50000/QALY, the 24-month strategy was most cost-effective in 40-year-old men ($48805/QALY), while the 6-month strategy was preferred in 40-year-old women ($35977/QALY) and 60-year-old men ($29878/QALY). In patients aged >/=80 years, 3-month anticoagulation was less costly and more effective than other strategies. Cost-effectiveness results were influenced by the risks associated with recurrent venous thromboembolism, the major bleeding risk of conventional-intensity anticoagulation and the disutility of taking warfarin.Longer initial conventional-intensity anticoagulation is cost-effective in younger patients while 3 months of anticoagulation is preferred in elderly patients. Patient age, sex, clinical factors, and patient preferences should be incorporated into medical decision making when selecting an appropriate anticoagulation strategy." @default.
• W2071449669 created "2016-06-24" @default.
• W2071449669 creator A5008746123 @default.
• W2071449669 creator A5027819939 @default.
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• W2071449669 date "2005-06-01" @default.
• W2071449669 modified "2023-10-01" @default.
• W2071449669 title "Oral anticoagulation strategies after a first idiopathic venous thromboembolic event" @default.
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• W2071449669 doi "https://doi.org/10.1016/j.amjmed.2005.02.018" @default.
• W2071449669 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/15922694" @default.
• W2071449669 hasPublicationYear "2005" @default.
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