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Canadian Journal of Cardiology

Integrated Management Approach to Atrial Fibrillation Care: A Cost Utility Analysis

Published:April 23, 2019DOI:https://doi.org/10.1016/j.cjca.2019.04.016

      Abstract

      Background

      Atrial fibrillation (AF) is a substantial burden on health care. Combined specialist and nurse-based AF clinics are associated with improved outcomes. However, Canadian data on the cost-effectiveness of this integrated management approach to AF care are lacking.

      Methods

      We evaluated health care costs and outcomes of 413 patients with newly-diagnosed AF in 3 emergency departments in Nova Scotia between January 1, 2011 and January 31, 2014. Using a before-after study design, patients were divided into usual care (228 patients) and intervention (185 patients) groups. The intervention was a nurse-run, physician-supervised AF clinic. Costs and quality-adjusted life years (QALYs) were compared between usual care and intervention. Costs were those incurred because of the clinical outcome, bleeding events, medications, and cardiovascular-related procedures. Probabilistic analysis was conducted to assess uncertainty.

      Results

      The AF clinic was associated with an average cost reduction of CAD$210.83 and an average improvement in QALY of 0.0007 per patient. The AF clinic was dominant over usual care despite higher operational and medication costs over 1 year. It provided greater cost-saving in approximately 66% of probabilistic analysis simulations and generated more QALYs in approximately 92% of simulations. An incremental cost-effectiveness ratio < $50,000 was found in 68% of simulations.

      Conclusions

      The present study provides guidance regarding the cost-effectiveness of an integrated management approach compared with usual specialty care of AF in a Canadian setting. We recommend further study be undertaken that prospectively plans for economic evaluation before definitive assessments of cost-effectiveness can be made.

      Résumé

      Introduction

      La fibrillation auriculaire (FA) est un fardeau important pour les soins de santé. Les cliniques de FA constituées d’infirmières et de spécialistes sont associées à de meilleurs résultats cliniques. Toutefois, les données canadiennes sur le rapport coût-efficacité de cette approche intégrée de prise en charge de la FA sont insuffisantes.

      Méthodes

      Nous avons évalué les coûts des soins de santé et les résultats cliniques de 413 patients ayant récemment reçu un diagnostic de FA dans 3 services d’urgence en Nouvelle-Écosse entre le 1er janvier 2011 et le 31 janvier 2014. À partir d’un plan d’étude avant-après, nous avons réparti les patients en 2 groupes : soins habituels (228 patients) et intervention (185 patients). L’intervention consistait en une clinique de FA dirigée par une infirmière et supervisée par un médecin. Nous avons comparé les coûts et les années de vie pondérées par la qualité (QALY, de l’anglais quality-adjusted life year) entre les soins habituels et l’intervention. Les coûts représentaient les coûts engendrés en raison des résultats cliniques, des événements hémorragiques, des médicaments et des interventions liées aux maladies cardiovasculaires. Nous avons réalisé une analyse probabiliste pour évaluer les incertitudes.

      Résultats

      Nous avons associé la clinique de FA à une réduction moyenne des coûts de 210,83 $ CA et à une amélioration moyenne des QALY de 0,0007 par patient. La clinique de FA prédominait dans les soins habituels en dépit des coûts plus élevés d’exploitation et de médicaments sur 1 année. Elle a permis d’offrir une plus grande réduction des coûts dans approximativement 66 % des simulations d’analyse probabiliste et généré plus de QALY dans approximativement 92 % des simulations. Nous avons observé un rapport coût-efficacité différentiel de < 50 000 $ CA dans 68 % des simulations.

      Conclusions

      La présente étude donne des orientations sur le rapport coût-efficacité d’une approche intégrée de prise en charge par rapport aux soins spécialisés habituels de la FA dans un contexte canadien. Nous recommandons d’entreprendre d’autres études qui permettent d’établir de manière prospective des plans d’évaluation économique avant de faire les évaluations finales du rapport coût-efficacité.
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      Linked Article

      • Reducing the Burden of Atrial Fibrillation Cost: Is Integrated Care the Answer?
        Canadian Journal of CardiologyVol. 35Issue 9
        • Preview
          Atrial fibrillation (AF) is an emerging global epidemic. Incidence and prevalence of the condition continues to exponentially rise and shows no sign of abating. AF is associated with significant morbidity and mortality including an increased risk of all-cause death, a five- to sevenfold increase in the risk of stroke and a threefold increase in the risk of heart failure. Furthermore, the number of hospitalizations due to AF have significantly increased across numerous countries and remain the most costly component of AF care delivery.
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