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Health technology assessment of oral anticoagulation following heart valve replacement

M. Perleth*,1 and R. Busse2

a Federal Association of Regional Health Insurance Funds, Berlin, Germany
b Euoopean Observatory on Health Care Systems (Madrid Hub), Escuela Nacional de Sanidad, Madrid, Spain

* Correspondence: Dr Matthias Perleth, MPH, Federal Association of Regional Health Insurance Funds, Rungestr. 3-6, 10179 Berlin, Germany.

Abstract

Aims The purpose of this report is to define the role that health technology assessment (HTA; a discipline in which both health outcomes and associated economic variables are investigated) can play in determining the effects of various anticoagulation regimens after mechanical heart valve replacement.

Method and results A review of literature, including meta-analyses and primary studies of oral anticoagulation after heart valve replacement, was conducted. The review revealed that a combination of low-dose anticoagulation and antithrombotic therapy is more beneficial than oral anticoagulation or antiplatelet therapy alone. The addition of high-dose antiplatelet therapy appeared to increase risk for haemorrhagic events, which was in constrast to the effect of low-dose antiplatelet therapy alone. However, the results from earlier studies are not always comparable to those of recent ones because of different reporting methods, various follow-up durations, and a tendency to report outcomes globally rather than presenting stratified analyses.

Conclusion HTA is as a tool with which to determine the most cost-effective therapy for each patient group. Various patient populations should be considered (stratified by sex, type and position of valve) within the scope of a comprehensive HTA, as well as therapeutic options. However, any HTA should be viewed critically and in light of the literature on which it is based.

Key Words: Anticoagulation • biomedical • heart valve replacement • meta-analysis • systematic review • technology assessment


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