{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:53:53Z","timestamp":1755795233977,"version":"3.44.0"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"foundation for cardiovascular research basel"},{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004362","name":"Schweizerische Herzstiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004362","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"crossref","award":["105318_189195 \/ 1","32003B_197524","32473B_176178","33CS30_148474","33CS30_177520"],"award-info":[{"award-number":["105318_189195 \/ 1","32003B_197524","32473B_176178","33CS30_148474","33CS30_177520"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,1,18]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Direct-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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>228 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 (\u20ac 20 940). The estimated incremental cost-effectiveness ratio was CHF 425 852 (\u20ac 387 138) per QALY gained.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002567","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T23:10:14Z","timestamp":1706742614000},"page":"e002567","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Patients on vitamin K treatment: is switching to direct-acting oral anticoagulation cost-effective? A target trial on a prospective cohort"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4418-9904","authenticated-orcid":false,"given":"Helena","family":"Aebersold","sequence":"first","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabienne","family":"Foster-Witassek","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-2421","authenticated-orcid":false,"given":"Stefanie","family":"Aeschbacher","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland"},{"name":"Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juerg H","family":"Beer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cantonal Hospital of Baden, Baden, Switzerland"},{"name":"Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Blozik","sequence":"additional","affiliation":[{"name":"Institute of Primary Care, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Blum","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland"},{"name":"Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo","family":"Bonati","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Basel, Basel, Switzerland"},{"name":"Research Department, Reha Rheinfelden, Rheinfelden, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Conte","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino (CCT), Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Coslovsky","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland"},{"name":"Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luisa","family":"De Perna","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcello","family":"Di Valentino","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Cardiocentro Ticino, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Felder","sequence":"additional","affiliation":[{"name":"Faculty of Business and Economics, University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola A","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Helsana Group, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4043-8061","authenticated-orcid":false,"given":"Giorgio","family":"Moschovitis","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Istituto Cardiocentro Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca E","family":"Paladini","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland"},{"name":"Cardiovascular Research Institute Basel, University Hospital Basel, Basel, 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