INTEGRATED MANAGEMENT APPROACH TO ATRIAL FIBRILLATION CARE: A COST UTILITY ANALYSIS

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 EDs in Nova Scotia between January 1, 2011-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 due to the clinical outcome, bleeding events, medications and CV-related operations. Probabilistic analysis was conducted to assess uncertainty. Results The AF clinic was associated with an average cost reduction of $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 one year. It provided greater cost-saving in approximately 66% of probabilistic analysis simulations and generated more QALY in approximately 92% of simulations. An incremental cost-effectiveness ratio below $50,000 was found in 68% of simulations. Conclusions The present study provides guidance regarding the cost-effectiveness of an integrated management approach compared to usual specialty care of AF in a Canadian setting. We recommend further study be undertaken that prospectively plan for economic evaluation before definitive assessments of cost-effectiveness can be made.