Cost-effectiveness of a clinical decision support system for atrial fibrillation: an RCT-based modelling study.

Area of Science:

• Cardiology
• Health Economics
• Medical Informatics

Background:

• Atrial fibrillation (AF) increases thromboembolism risk, necessitating anticoagulation.
• Underuse of anticoagulation in AF patients remains a significant clinical challenge.
• Clinical Decision Support (CDS) systems show potential to improve guideline adherence for anticoagulation in AF.

Purpose of the Study:

• To evaluate the cost-effectiveness of a Clinical Decision Support (CDS) system for managing anticoagulation in patients with Atrial Fibrillation (AF).
• To assess the economic impact of a CDS intervention compared to standard care in AF patients.
• To determine if CDS for AF anticoagulation meets established cost-effectiveness thresholds.

Main Methods:

• A Markov-based disease progression model simulated hypothetical AF patients under standard care versus a CDS strategy.
• Anticoagulation adherence data was derived from the CDS-AF trial.
• Cost-effectiveness was analyzed over a lifetime horizon, calculating Quality-Adjusted Life Years (QALYs) and Incremental Cost-Effectiveness Ratios (ICERs), with sensitivity analyses performed.

Main Results:

• The CDS intervention led to a reduction in ischemic strokes but an increase in bleeding events.
• A mean gain of 0.012 QALYs per patient was observed.
• The Incremental Cost-Effectiveness Ratio (ICER) was €963 per QALY gained, well below the €50,000 threshold.

Conclusions:

• The CDS intervention for AF anticoagulation demonstrates significant health gains.
• The intervention is highly cost-effective, with a low ICER per QALY gained.
• The findings suggest that CDS systems are a valuable tool for improving AF management and warrant wider implementation.