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  • Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care – a multi-state survival model based on a randomized controlled trial

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    Author(s)
    Gao, Lan
    Scuffham, Paul
    Ball, Jocasta
    Stewart, Simon
    Byrnes, Joshua
    Griffith University Author(s)
    Byrnes, Joshua M.
    Scuffham, Paul A.
    Year published
    2021
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    Abstract
    Aim: To assess the long-term cost-effectiveness of an atrial fibrillation disease management program (i.e. the SAFETY program) from the Australian healthcare system perspective. Methods: A multistate Markov model was developed based on patient-level data from the SAFETY randomized controlled trial. Predicted long-term survival, dependent on hospital admission history, was estimated by extrapolating parametric survival models. Quality-adjusted life years (QALY) and life years (LY) were the primary and secondary outcome measures used to estimate the incremental costutility/effectiveness ratio (ICUR/ICER). Both deterministic ...
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    Aim: To assess the long-term cost-effectiveness of an atrial fibrillation disease management program (i.e. the SAFETY program) from the Australian healthcare system perspective. Methods: A multistate Markov model was developed based on patient-level data from the SAFETY randomized controlled trial. Predicted long-term survival, dependent on hospital admission history, was estimated by extrapolating parametric survival models. Quality-adjusted life years (QALY) and life years (LY) were the primary and secondary outcome measures used to estimate the incremental costutility/effectiveness ratio (ICUR/ICER). Both deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: The SAFETY program was associated with both higher costs ($94,953 vs. $78,433) and benefits [QALY (3.99 vs 3.60); LY (5.86 vs 5.24)], with an ICUR of $42,513/QALY or ICER of $26,356/LY, compared to standard care. Due to the extended survival, the SAFETY was associated with a greater number of hospitalizations (14.85 vs 11.65) and higher costs for medications ($25,084 vs $22,402) and outpatient care ($12,904 vs $11,524). The cost per hospitalization for an average length of stay, analytical time horizon, and cost of medication are key determinants of ICUR. The PSA showed that the intervention has a 70.4% probability of being cost-effective at a threshold of $50,000/QALY. Conclusions: The SAFETY program has a high probability of being cost-effective for patients with atrial fibrillation. It is associated with uncertainty that further research could potentially eliminate; implementation with further evidence collection is recommended.
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    Journal Title
    Journal of Medical Economics
    Volume
    24
    Issue
    1
    DOI
    https://doi.org/10.1080/13696998.2020.1860371
    Copyright Statement
    © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
    Subject
    Public Health and Health Services
    Applied Economics
    Psychology
    Publication URI
    http://hdl.handle.net/10072/401013
    Collection
    • Journal articles

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