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Published on: February 26, 2013
Rapid Access Atrial Fibrillation Clinics in Australia - Modelling Outcomes and Cost-Effectiveness
Adam C Livori1,2,3,4, Ansu Alex5, Tamrat Abebe6,7
1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, Sciences, Monash University, Melbourne, VIC, Australia. adam.livori@monash.edu.
Insights
Rapid Access Atrial Fibrillation (RAAF) clinics effectively prevent strokes and bleeding events in patients. These clinics are cost-saving, demonstrating a positive return on investment for healthcare systems.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Atrial fibrillation (AF) management requires risk assessment and anticoagulation for stroke prevention.
- Rapid Access Atrial Fibrillation (RAAF) clinics offer multidisciplinary care to minimize stroke risk duration.
- The clinical outcomes and cost-effectiveness of RAAF clinics remain under investigation.
Purpose of the Study:
- To conduct a cost-effectiveness evaluation of an RAAF clinic from a healthcare system perspective.
- To compare the RAAF clinic model against standard care in Australia.
Main Methods:
- A microsimulation model was developed using data from 274 individuals referred to an RAAF clinic.
- Stroke, bleeding, and death risks were estimated using the GARFIELD equation.
- A comparator cohort received standard care via a general cardiology clinic over a 2-year horizon, with 1000 replications.
Main Results:
- RAAF clinic participants experienced fewer strokes, bleeding events, and deaths compared to standard care.
- Marginal increases in quality-adjusted life years (QALYs) were observed.
- The RAAF clinic model resulted in cost savings of AUD$74 per person, with a dominant incremental cost-effectiveness ratio (ICER).
Conclusions:
- RAAF clinics are effective in preventing strokes and bleeding events in AF patients.
- These clinics are cost-saving and offer potential returns on investment.
- Adoption of the RAAF clinic model by policymakers can improve the delivery of safe, effective, and economical care for AF patients.
Aims:
Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but their clinical outcomes and cost-effectiveness are uncertain. This study aimed to perform a cost-effectiveness evaluation, from a healthcare system perspective, of an RAAF clinic within a large regional health service in Australia.
Methods:
We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022 and 2023. Clinic data were used to determine risk of stroke, major bleeding and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with standard of care, which were used to determine incremental cost-effectiveness ratios (ICER), with 5% annual discounting.
Results:
The RAAF clinic participants experienced fewer strokes (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.
Conclusions:
RAAF clinics are likely to prevent strokes and bleeding, are cost-saving and could lead to returns on investment. Adoption of this model of care by policy-makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding and death in people with atrial fibrillation.
