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Updated: Aug 12, 2025
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Published on: February 26, 2013
A Cost-Effectiveness Analysis of Biomarkers for Risk Prediction in Atrial Fibrillation
Gisèle Nakhlé1,2, Jean-Claude Tardif3,4, Denis Roy3,4
1CHUM Research Center, Pavilion S, 850, St-Denis St., S03.300, Montreal, QC, H2X 0A9, Canada. gisele.nakhle@umontreal.ca.
Insights
Precision medicine (PM) using biomarkers and clinical data improves atrial fibrillation (AF) stroke risk prediction. This approach is cost-effective, reducing healthcare costs and improving patient outcomes compared to standard care.
Area of Science:
- Cardiology
- Biomarkers
- Health Economics
Background:
- Atrial fibrillation (AF) increases thromboembolism risk, with current clinical scoring systems having limited prognostic accuracy.
- Circulating biomarkers offer potential for improved risk prediction and personalized treatment in AF patients.
- There is a need for enhanced risk stratification tools in AF management.
Purpose of the Study:
- To evaluate the cost-effectiveness of precision medicine (PM) versus standard of care (SOC) for stroke risk stratification in AF patients.
- To compare the economic and clinical outcomes of PM and SOC over a 20-year period.
- To determine if PM represents a dominant strategy for managing AF-related stroke risk.
Main Methods:
- A Markov cohort model was utilized to simulate outcomes from a Canadian healthcare system perspective.
- The model compared costs and quality-adjusted life-years (QALYs) for PM and SOC over two decades.
- Sensitivity analyses, including one-way and probabilistic, were performed to assess result robustness.
Main Results:
- Precision medicine (PM) reduced mean per-patient costs by 7% (CAD $94,932 vs $102,057).
- PM increased mean QALYs by 12% (8.77 vs 7.68 QALYs).
- The incremental cost-effectiveness ratio was negative, signifying PM as an economically dominant strategy.
Conclusions:
- Precision medicine (PM) is an economically dominant strategy for AF stroke risk stratification.
- Implementing PM is projected to generate significant cost savings within the healthcare system.
- Combined biomarker and clinical variable assessment offers a superior approach to standard care for AF patients.
Rationale:
Atrial fibrillation (AF) is associated with an increased risk of thromboembolism. This risk is currently assessed with scoring systems based on clinical characteristics. However, these tools have limited prognostic performance. Circulating biomarkers are proposed for improved prediction of major clinical events and individualization of treatments in patients with AF.
Objective:
The aim was to assess the cost-effectiveness of precision medicine (PM), i.e., the use of combined biomarkers and clinical variables, in comparison to standard of care (SOC) for risk stratification in a hypothetical cohort of AF patients at risk of stroke.
Methods:
A Markov cohort model was developed to evaluate the costs and quality-adjusted life-years (QALYs) of PM compared to SOC, over 20 years using a Canadian healthcare system perspective.
Results:
PM decreased the mean per-patient overall costs by 7% ($94,932 vs $102,057 [Canadian dollars], respectively) and increased the QALYs by 12% (8.77 vs 7.68 QALYs, respectively). The calculated incremental cost-effectiveness ratio was negative, indicating that PM is an economically dominant strategy. These results were robust to one-way and probabilistic sensitivity analyses.
Conclusion:
PM compared to SOC is economically dominant and is projected to generate cost savings.
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