ArticleCJEM2025
Cost-utility analysis of routine oral anticoagulation for low-risk patients undergoing cardioversion for atrial fibrillation and flutter.
Article in CJEM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
6 authors.
Funding
Abstract
purposeCanadian guidelines suggest that physicians should consider prescribing four weeks of oral anticoagulation (OAC) for patients undergoing cardioversion for acute atrial fibrillation/flutter (AF/AFL), regardless of stroke risk. While the risk of stroke following cardioversion may be low, the morbidity and cost from a stroke is significant. This study aims to evaluate the cost-effectiveness of routinely providing OAC after cardioversion.
methodsWe conducted a cost-utility analysis comparing no-OAC post-cardioversion to four weeks of OAC, from the perspective of the Canadian public payer, in adults with acute AF/AFL and no risk factors based on the CCS Algorithm (CHADS-65). A decision tree was used to estimate clinical outcomes, quality-of-life, and costs. Results were expressed as quality-adjusted life days and an incremental net monetary benefit. We performed a probabilistic sensitivity analysis using 10,000 Monte Carlo simulations to assess the robustness of our findings.
resultsNo-OAC was found to be dominant, with slightly increased quality-of-life (296 quality-adjusted life days vs. 295 quality-adjusted life days) at a lower cost [CAN$108.86 (95%CI $107.38-$110.34) vs. CAN$117.73 (95%CI $116.54-$118.91)] and an incremental net monetary benefit of $25.22 (95%CI $19.21-$31.23). A probabilistic sensitivity analysis showed the no-OAC option was cost-effective in 69.5% iterations. The results were driven by low event rates post-cardioversion.
conclusionThere were minimal differences between strategies and forgoing anticoagulation resulted in very slight improvement in quality-of-life at a reduced cost. We hope this provides guidance to physicians and look to see this evidence incorporated into Canadian guidelines for atrial fibrillation.
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