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March 27, 1996

Cost-effectiveness of Stroke Prophylaxis for Nonvalvular Atrial Fibrillation-Reply

Author Affiliations

Washington University St Louis, Mo
Stanford University Stanford, Calif

JAMA. 1996;275(12):910. doi:10.1001/jama.1996.03530360019024

In Reply.  —We appreciate the interest of Drs Kan and Katz in our analysis.1 They are correct that our wide estimate of the cost-effectiveness of warfarin therapy in 65-year-old low-risk patients is a consequence of the minimal average gain (0.01 QALY) conferred by treating these patients with warfarin instead of aspirin. They are also correct in noting that the cost-effectiveness of warfarin therapy is sensitive to patient preferences2 as well as to risk of stroke. In fact, warfarin will be cost-effective even in some (highly selected) 65-year-old patients with NVAF and no other clinical risk factors for stroke (ie, low-risk patients who indicate that warfarin therapy would not affect their quality of life or who have an ominous echocardiogram that portends stroke).We disagree, however, with the suggestion that we apply the 4.3% annual rate of stroke to our low-risk cohort. Because our low-risk cohort was defined identically