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Updated: Jan 20, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Integrated Management Approach to Atrial Fibrillation Care: A Cost Utility Analysis
Manoj K Saraswat1, Lindsey Carter1, Patrick Berrigan2
1Department of Medicine, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
Insights
An integrated nurse-led atrial fibrillation (AF) clinic in Canada reduced healthcare costs and improved quality-adjusted life years (QALYs). This approach proved cost-effective, offering significant savings and better patient outcomes compared to usual care.
Area of Science:
- Health Economics
- Cardiology
- Healthcare Management
Background:
- Atrial fibrillation (AF) presents a significant healthcare burden.
- Integrated specialist and nurse-based AF clinics demonstrate improved patient outcomes.
- Canadian data on the cost-effectiveness of integrated AF management is limited.
Purpose of the Study:
- To evaluate the cost-effectiveness of a nurse-run, physician-supervised AF clinic compared to usual care in Nova Scotia, Canada.
- To assess healthcare costs and quality-adjusted life years (QALYs) associated with integrated AF management.
Main Methods:
- A before-after study design involving 413 newly diagnosed AF patients across three emergency departments.
- Comparison of usual care (228 patients) versus an intervention group (185 patients) receiving care at an AF clinic.
- Analysis of healthcare costs (clinical outcomes, bleeding, medications, procedures) and QALYs, with probabilistic analysis to assess uncertainty.
Main Results:
- The AF clinic resulted in an average cost reduction of CAD$210.83 and an average QALY improvement of 0.0007 per patient.
- The integrated approach was dominant over usual care, showing cost savings in 66% and improved QALYs in 92% of simulations.
- An incremental cost-effectiveness ratio under $50,000 was observed in 68% of simulations.
Conclusions:
- The integrated management approach of AF clinics is cost-effective in a Canadian setting.
- Further prospective studies with planned economic evaluations are recommended for definitive cost-effectiveness assessments.
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.
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