Official websites use. Share sensitive information only on official, secure websites. Correspondence to Dr Helena Aebersold; helena. The target trial approach was applied to the prospective observational Swiss-AF cohort, which enrolled AF patients from to 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 patients 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. The estimated gain in quality-adjusted life years QALYs was 0. Applying 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. Keywords: epidemiology, atrial fibrillation, health care economics and organizations.
We applied target trial emulation, a causal inference method, to study cost-effectiveness using real-world prospective cohort and insurance claims data. In atrial fibrillation AF patients, oral anticoagulation is used to prevent strokes effectively. DOACs were developed to overcome the limitations of VKA treatments, such as constant anticoagulation monitoring or drug interactions.
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However, none of the studies based on real-world data have used an explicit causal method to estimate costs and effects. Using data from the prospective Swiss-AF cohort study, we aimed to assess the causal empirical incremental cost-effectiveness and quality-of-life effects in patients switching from VKA treatment to DOAC compared with patients maintaining VKA.
