Abstract:
BACKGROUND:Warfarin reduces the risk for ischemic stroke in patients with atrial fibrillation (AF) but increases the risk for hemorrhage. Dabigatran is a fixed-dose, oral direct thrombin inhibitor with similar or reduced rates of ischemic stroke and intracranial hemorrhage in patients with AF compared with those of warfarin. OBJECTIVE:To estimate the quality-adjusted survival, costs, and cost-effectiveness of dabigatran compared with adjusted-dose warfarin for preventing ischemic stroke in patients 65 years or older with nonvalvular AF. DESIGN:Markov decision model. DATA SOURCES:The RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial and other published studies of anticoagulation. The cost of dabigatran was estimated on the basis of pricing in the United Kingdom. TARGET POPULATION:Patients aged 65 years or older with nonvalvular AF and risk factors for stroke (CHADS₂ score ≥1 or equivalent) and no contraindications to anticoagulation. TIME HORIZON:Lifetime. PERSPECTIVE:Societal. INTERVENTION:Warfarin anticoagulation (target international normalized ratio, 2.0 to 3.0); dabigatran, 110 mg twice daily (low dose); and dabigatran, 150 mg twice daily (high dose). OUTCOME MEASURES:Quality-adjusted life-years (QALYs), costs (in 2008 U.S. dollars), and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS:The quality-adjusted life expectancy was 10.28 QALYs with warfarin, 10.70 QALYs with low-dose dabigatran, and 10.84 QALYs with high-dose dabigatran. Total costs were $143 193 for warfarin, $164 576 for low-dose dabigatran, and $168 398 for high-dose dabigatran. The incremental cost-effectiveness ratios compared with warfarin were $51 229 per QALY for low-dose dabigatran and $45 372 per QALY for high-dose dabigatran. RESULTS OF SENSITIVITY ANALYSIS:The model was sensitive to the cost of dabigatran but was relatively insensitive to other model inputs. The incremental cost-effectiveness ratio increased to $50 000 per QALY at a cost of $13.70 per day for high-dose dabigatran but remained less than $85 000 per QALY over the full range of model inputs evaluated. The cost-effectiveness of high-dose dabigatran improved with increasing risk for stroke and intracranial hemorrhage. LIMITATION:Event rates were largely derived from a single randomized clinical trial and extrapolated to a 35-year time frame from clinical trials with approximately 2-year follow-up. CONCLUSION:In patients aged 65 years or older with nonvalvular AF at increased risk for stroke (CHADS₂ score ≥1 or equivalent), dabigatran may be a cost-effective alternative to warfarin depending on pricing in the United States. PRIMARY FUNDING SOURCE:American Heart Association and Veterans Affairs Health Services Research & Development Service.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Freeman JV,Zhu RP,Owens DK,Garber AM,Hutton DW,Go AS,Wang PJ,Turakhia MPdoi
10.7326/0003-4819-154-1-201101040-00289subject
Has Abstractpub_date
2011-01-04 00:00:00pages
1-11issue
1eissn
0003-4819issn
1539-3704pii
0003-4819-154-1-201101040-00289journal_volume
154pub_type
杂志文章abstract:BACKGROUND:Growing evidence indicates that peripheral neuropathy (PN) is common even in the absence of diabetes. However, the clinical sequelae of PN have not been quantified in the general population. OBJECTIVE:To assess the associations of PN with all-cause and cardiovascular mortality in the general adult populatio...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-1340
更新日期:2020-12-08 00:00:00
abstract::Thirty-five consecutive patients with progressive systemic sclerosis were prospectively evaluated for evidence of Sjögren's syndrome. Six of the 35 (17%) were judged to have the disorder. This is a higher prevalence than in most reports, but much lower than that recently reportedly by Alarcón-Segovia and associates (7...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-5-535
更新日期:1977-11-01 00:00:00
abstract::The exocrine pancreas secretes into the gut on demand more than 20 proteins that are indispensable for digestion. In-vivo autodigestion is prevented by an array of natural safeguards. In acute pancreatitis, inappropriate intrapancreatic activation and release of pancreatic hydrolases occur, but the pathogenetic mechan...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-103-1-86
更新日期:1985-07-01 00:00:00
abstract::Transmission of the human immunodeficiency virus (HIV) was studied in a group of patients with cancer who received transfusion of blood components harvested from a single, asymptomatic, seropositive donor. Of ten living recipients, nine had antibodies to the virus in fresh or cryopreserved sera at a median of 384 days...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-4-519
更新日期:1986-10-01 00:00:00
abstract::Immediately after the liberation of Kuwait by a coalition of allied forces in March 1991, representatives of Physicians for Human Rights traveled to Kuwait and conducted an inquiry into human rights violations allegedly perpetrated by Iraqi forces. The inquiry focused on the abuses that were said to have occurred in h...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-117-1-78
更新日期:1992-07-01 00:00:00
abstract::Eighty-six patients who required heparin therapy were randomly assigned to receive bovine or porcine heparin. Abnormal concentrations of alanine transaminase and aspartate transaminase developed during treatment in 59.3% and 26.7% of patients, respectively. Patient characteristics that significantly influenced the dev...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-100-5-646
更新日期:1984-05-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of continuous intravenous infusion of prostacyclin (epoprostenol) in primary pulmonary hypertension. DESIGN:Randomized trial with 8-week treatment periods and nonrandomized treatment for up to 18 months. SETTING:Four referral centers. PATIENTS:Sequential sample of 24 patient...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-112-7-485
更新日期:1990-04-01 00:00:00
abstract::The clinical significance of anatomic substage was assessed in 130 patients with Hodgkin's disease in pathologic stage III-A: stage III1-A includes involvement of spleen, or splenic, celiac, or portal nodes, or any combination of these; stage III2-A includes involvement of para-aortic, iliac, or mesenteric nodes, with...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-2-159
更新日期:1980-02-01 00:00:00
abstract:BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic continues to surge in the United States and globally. OBJECTIVE:To describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery. DESIGN:Single-health system, multihospital retrospective cohort study. SETTING...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-5327
更新日期:2021-01-19 00:00:00
abstract::Clinical ecologists propose the existence of a unique illness in which multiple environmental chemicals, foods, drugs, and endogenous C. albicans have a toxic effect on the immune system, thereby adversely affecting other bodily functions. The proposal uses some concepts that superficially resemble those that apply to...
journal_title:Annals of internal medicine
pub_type: 指南,杂志文章,实务指引,评审
doi:
更新日期:1989-07-15 00:00:00
abstract:STUDY OBJECTIVE:To determine the safety of withholding anticoagulant therapy in pregnant patients with clinically suspected deep-vein thrombosis who have negative results by serial impedance plethysmography. DESIGN:Prospective study evaluating prognosis by long-term follow-up to 3 months postpartum in all patients. S...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-9-663
更新日期:1990-05-01 00:00:00
abstract:BACKGROUND:Castleman disease, an unusual condition of unknown cause consisting of a massive proliferation of lymphoid tissue, remains a clinicopathologic diagnosis. Three histologic variants (hyaline vascular, plasma-cell, and mixed) and two clinical types (localized and multicentric) of Castleman disease have been des...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-8-199804150-00010
更新日期:1998-04-15 00:00:00
abstract:BACKGROUND:Urine tests for Chlamydia trachomatis permit expansion of screening beyond traditional clinic environments. Prevention of infection in teenagers is a high priority. OBJECTIVE:To define the prevalence of C. trachomatis among teenagers by using the ligase chain reaction assay on urine specimens and to evaluat...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-127-9-199711010-00004
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:Nurse care management programs for patients with chronic illness have been shown to be safe and effective. OBJECTIVE:To determine whether a telephone-mediated nurse care management program for heart failure reduced the rate of rehospitalization for heart failure and for all causes over a 1-year period. DES...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-141-8-200410190-00008
更新日期:2004-10-19 00:00:00
abstract::The four main conceptual paradigms of basic biomedical research are that the explication of mechanisms is a primary goal of science; that scientific data must be "hard"; that formulation of hypotheses and counter-hypotheses is a principal creative challenge; and that experiments are the main mechanism for using scient...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-99-3-393
更新日期:1983-09-01 00:00:00
abstract:BACKGROUND:With suspected deep venous thrombosis and normal results on proximal vein ultrasonography, a negative d-dimer result may exclude thrombosis and a positive D-dimer result may be an indication for venography. OBJECTIVE:To evaluate and compare the safety of 2 diagnostic strategies for deep venous thrombosis. ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-142-7-200504050-00007
更新日期:2005-04-05 00:00:00
abstract:OBJECTIVE:To determine whether a cytogenetic response after interferon-alpha therapy in patients with chronic myelogenous leukemia is independently associated with improved survival. DESIGN:Retrospective analysis. PATIENTS:274 patients with a diagnosis of Philadelphia chromosome-positive chronic myelogenous leukemia ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-122-4-199502150-00003
更新日期:1995-02-15 00:00:00
abstract:BACKGROUND:Impressive decreases in cardiovascular mortality have been achieved through risk factor reduction and clinical intervention, yet cardiovascular disease remains a leading cause of death nationally. OBJECTIVE:To estimate up-to-date preventable fractions of cardiovascular mortality associated with elimination ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M14-1753
更新日期:2015-08-18 00:00:00
abstract:BACKGROUND:Risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to close contacts of infected persons has not been well estimated. OBJECTIVE:To evaluate the risk for transmission of SARS-CoV-2 to close contacts in different settings. DESIGN:Prospective cohort study. SETTING:Close con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-2671
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abstract:DESCRIPTION:Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for peripheral artery disease (PAD). METHODS:The USPSTF reviewed the evidence on the use of resting ankle-brachial index (ABI) as a screening test for PAD or as a risk predictor for cardiovascular disease (CVD). The...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-159-5-201309030-00008
更新日期:2013-09-03 00:00:00
abstract:PURPOSE:To evaluate the use of thyroid function tests to monitor therapy in patients taking levothyroxine. DATA IDENTIFICATION:Studies published between 1966 and January 1990 were identified through computer searches and references of identified studies. STUDY SELECTION:Studies that included a careful description of ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-113-6-450
更新日期:1990-09-15 00:00:00
abstract::Intensive care is one of the largest, most expensive, and complex components of U.S. health care. Errors and the resulting adverse events are, however, common in intensive care units (ICUs). Theories about errors in high-risk environments, developed by aviation and other industries, provide insight into why ICUs are p...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-140-12-200406150-00013
更新日期:2004-06-15 00:00:00
abstract:OBJECTIVE:To study the relation between housestaff coverage schedules and the occurrence of preventable adverse events. DESIGN:Case-control study. SETTING:Urban teaching hospital. PATIENTS:All 3146 patients admitted to the medical service during a 4-month period. MEASUREMENTS:A previously tested confidential self-r...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-121-11-199412010-00008
更新日期:1994-12-01 00:00:00
abstract::In April 1976 the attack rate of chills and fever with or without falls in blood pressure increased in association with cardiac catheterizations. Fevers were associated with coronary angiography and right and left heart catheterizations. Blood cultures were negative, and reactions did not correlate with amounts of con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-1-32
更新日期:1980-07-01 00:00:00
abstract::The U.S. Preventive Services Task Force (USPSTF) makes recommendations on which preventive services to routinely incorporate into primary care for specific populations. Behavioral counseling interventions are preventive services designed to help persons engage in healthy behaviors and limit unhealthy ones. The USPSTF'...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M13-2128
更新日期:2014-03-18 00:00:00
abstract:BACKGROUND:Ulcerative colitis is predominantly a disease of nonsmokers. Transdermal nicotine may help control clinical manifestations of this condition. OBJECTIVE:To determine the efficacy of transdermal nicotine for controlling clinical disease activity in active ulcerative colitis. DESIGN:Randomized, double-blind, ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-126-5-199703010-00004
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:AL amyloidosis is a fatal disease resulting from tissue deposition of amyloid fibrils derived from monoclonal immunoglobulin light chains. Treatment with oral chemotherapy is minimally effective. OBJECTIVE:To test survival and organ response in a large sample of patients treated with high-dose intravenous m...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-140-2-200401200-00008
更新日期:2004-01-20 00:00:00
abstract:Description:The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update an...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/M17-2640
更新日期:2018-03-20 00:00:00
abstract:BACKGROUND:Although the efficacy of adjuvant chemotherapy in prolonging survival for women with breast cancer has been well documented, limited population-based information is available on the actual use of chemotherapy. OBJECTIVE:To examine the relationship between age and chemotherapy use. DESIGN:Cohort study. SET...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-2-200301210-00009
更新日期:2003-01-21 00:00:00
abstract:OBJECTIVE:To determine the causes of persistent dizziness in outpatients. DESIGN:Consecutive adult outpatients presenting with a chief complaint of dizziness. SETTING:Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. PATIENTS:Of 185 patients presenting during the 10-mon...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-11-898
更新日期:1992-12-01 00:00:00