File(s) stored somewhere else
Please note: Linked content is NOT stored on Torrens University Australia and we can't guarantee its availability, quality, security or accept any liability.
Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care–a multi-state survival model based on a randomized controlled trial.
journal contribution
posted on 2021-03-23, 23:51 authored by Lan Gao, Paul Scuffham, Jocasta Ball, Simon StewartSimon Stewart, Joshua ByrnesABSTRACT
Aim: To assess the long-term cost-effectiveness of an atrial fibrillation disease management program
(i.e. the SAFETY program) from the Australian healthcare system perspective.
Methods: A multistate Markov model was developed based on patient-level data from the SAFETY
randomized controlled trial. Predicted long-term survival, dependent on hospital admission history,
was estimated by extrapolating parametric survival models. Quality-adjusted life years (QALY) and life
years (LY) were the primary and secondary outcome measures used to estimate the incremental costutility/effectiveness ratio (ICUR/ICER). Both deterministic and probabilistic sensitivity analyses (PSA)
were undertaken.
Results: The SAFETY program was associated with both higher costs ($94,953 vs. $78,433) and benefits [QALY (3.99 vs 3.60); LY (5.86 vs 5.24)], with an ICUR of $42,513/QALY or ICER of $26,356/LY, compared to standard care. Due to the extended survival, the SAFETY was associated with a greater
number of hospitalizations (14.85 vs 11.65) and higher costs for medications ($25,084 vs $22,402) and
outpatient care ($12,904 vs $11,524). The cost per hospitalization for an average length of stay, analytical time horizon, and cost of medication are key determinants of ICUR. The PSA showed that the
intervention has a 70.4% probability of being cost-effective at a threshold of $50,000/QALY.
Conclusions: The SAFETY program has a high probability of being cost-effective for patients with
atrial fibrillation. It is associated with uncertainty that further research could potentially eliminate;
implementation with further evidence collection is recommended.