Evidence map›Paper›PMID 38302139›Full record

Observational studyOpen heart2024

Patients on vitamin K treatment: is switching to direct-acting oral anticoagulation cost-effective? A target trial on a prospective cohort.

Helena Aebersold, Fabienne Foster-Witassek, Stefanie Aeschbacher, Juerg H Beer, Eva Blozik, Manuel Blum, Leo Bonati, Giulio Conte, Michael Coslovsky, Maria Luisa De Perna and 17 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Open heart, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Helena AebersoldEpidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland helena.aebersold@uzh.ch.ORCID 0000-0002-4418-9904
Fabienne Foster-WitassekEpidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Stefanie AeschbacherCardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.ORCID 0000-0001-8134-2421
Juerg H BeerDepartment of Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
Eva BlozikInstitute of Primary Care, University of Zurich, Zurich, Switzerland.
Manuel BlumInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Leo BonatiDepartment of Neurology, University Hospital Basel, Basel, Switzerland.
Giulio ConteDivision of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland.
Michael CoslovskyCardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
Maria Luisa De PernaDivision of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland.
Marcello Di ValentinoDivision of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland.
Stefan FelderFaculty of Business and Economics, University of Basel, Basel, Switzerland.
Carola A HuberDepartment of Health Sciences, Helsana Group, Zurich, Switzerland.
Giorgio MoschovitisDivision of Cardiology, Ente Ospedaliero Cantonale (EOC), Istituto Cardiocentro Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.ORCID 0000-0002-4043-8061
Andreas MuellerDepartment of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
Rebecca E PaladiniCardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Tobias ReichlinDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Nicolas RodondiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Annina StauberDepartment of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland.
Christian SticherlingCardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Thomas D SzucsHealth Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland.
David ConenPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Michael KuhneCardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Stefan OsswaldCardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Matthias Schwenkglenks *Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Miquel Serra-Burriel *Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Swiss-AF Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsDirect-acting oral anticoagulants (DOACs) have, to a substantial degree, replaced vitamin K antagonists (VKA) as treatments for stroke prevention in atrial fibrillation (AF) patients. However, evidence on the real-world causal effects of switching patients from VKA to DOAC is lacking. We aimed to assess the empirical incremental cost-effectiveness of switching patients to DOAC compared with maintaining VKA treatment.

methodsThe target trial approach was applied to the prospective observational Swiss-AF cohort, which enrolled 2415 AF patients from 2014 to 2017. Clinical data, healthcare resource utilisation and EQ-5D-based utilities representing quality of life were collected in yearly follow-ups. Health insurance claims were available for 1024 patients (42.4%). Overall survival, quality-of-life, costs from the Swiss statutory health insurance perspective and cost-effectiveness were estimated by emulating a target trial in which patients were randomly assigned to switch to DOAC or maintain VKA treatment.

results228 patients switching from VKA to DOAC compared with 563 patients maintaining VKA treatment had no overall survival advantage over a 5-year observation period (HR 0.99, 95% CI 0.45, 1.55). The estimated gain in quality-adjusted life years (QALYs) was 0.003 over the 5-year period at an incremental costs of CHF 23 033 (€ 20 940). The estimated incremental cost-effectiveness ratio was CHF 425 852 (€ 387 138) per QALY gained.

conclusionsApplying a causal inference method to real-world data, we could not demonstrate switching to DOACs to be cost-effective for AF patients with at least 1 year of VKA treatment. Our estimates align with results from a previous randomised trial.

Indexed as

Atrial FibrillationStrokeAnticoagulantsCost-Benefit AnalysisHumansProspective StudiesQuality of LifeVitamin KAnticoagulantsVitamin Katrial fibrillationepidemiologyhealth care economics and organizations

Identifiers

PMID38302139
PMCPMC10831440

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.