Related Experiment Video
Updated: Jan 17, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Cost-effectiveness of a clinical decision support system for atrial fibrillation: an RCT-based modelling study
Olof Persson Lindell1,2, Martin Henriksson3, Lars O Karlsson1,2
1Department of Cardiology, Linköping University Hospital, Kardiologiska Kliniken, Universitetssjukhuset, Linköping 581 85, Sweden.
Insights
Clinical decision support (CDS) systems improve anticoagulation adherence in atrial fibrillation (AF), reducing strokes. This study found a CDS intervention for AF is cost-effective, offering significant health gains at a low cost per QALY gained.
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.
Aims:
Atrial fibrillation (AF) is a common arrythmia that increases the risk of thromboembolism. Despite the effectiveness of anticoagulation in AF, underuse remains a substantial problem. Clinical decision support (CDS) systems may increase adherence to guideline recommended anticoagulation in AF. However, evidence regarding the cost-effectiveness of these interventions is lacking. The aim of this study was therefore to evaluate the cost-effectiveness of a CDS for AF.
Methods And Results:
We developed a disease progression model with a Markov structure and simulated a cohort of hypothetical individuals with AF through a standard of care and a CDS strategy. The adherence to anticoagulation in the model was based on the treatment effect reported in the CDS-AF trial, which evaluated the effect of a CDS in patients with AF in the primary care in Östergötland, Sweden. The cost-effectiveness of the CDS-AF intervention compared with standard of care was determined by estimating costs and quality-adjusted life years (QALYs) gained over a lifetime time horizon and was reported as an incremental cost-effectiveness ratio (ICER) assessed against a decision-threshold of €50 000. Uncertainty was evaluated using both one-way and probabilistic sensitivity analysis (PSA). The CDS-intervention resulted in fewer ischaemic strokes but more bleedings. The mean per patient gain in QALYs was 0.012 and the ICER was €963 per QALY gained. The result of the PSA indicated a high probability that the ICER was below €50 000.
Conclusion:
The CDS intervention used in the CDS-AF trial appears to yield health gains at a lower cost than typically considered cost-effective.
Trial Registration:
NCT02635685.
Related Concept Videos
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:30Acute Coronary Syndrome III: Diagnostic Studies