期刊
CANADIAN JOURNAL OF CARDIOLOGY
卷 35, 期 9, 页码 1142-1148出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cjca.2019.04.016
关键词
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资金
- Pfizer Canada
- Bayer Canada
- Boehringer-Ingelheim
- Nova Scotia Health Authority Research Fund
- Cardiac Arrhythmia Network of Canada as part of the Networks of Centres of Excellence
- Research in Medicine program at Dalhousie University's Faculty of Medicine
Background: Atrial fibrillation (AF) is a substantial burden on health care. Combined specialist and nurse-based AF clinics are associated with improved outcomes. However, Canadian data on the cost-effectiveness of this integrated management approach to AF care are lacking. Methods: We evaluated health care costs and outcomes of 413 patients with newly-diagnosed AF in 3 emergency departments in Nova Scotia between January 1, 2011 and January 31, 2014. Using a before-after study design, patients were divided into usual care (228 patients) and intervention (185 patients) groups. The intervention was a nurse-run, physician-supervised AF clinic. Costs and quality-adjusted life years (QALYs) were compared between usual care and intervention. Costs were those incurred because of the clinical outcome, bleeding events, medications, and cardiovascular-related procedures. Probabilistic analysis was conducted to assess uncertainty. Results: The AF clinic was associated with an average cost reduction of CAD$210.83 and an average improvement in QALY of 0.0007 per patient. The AF clinic was dominant over usual care despite higher operational and medication costs over 1 year. It provided greater costsaving in approximately 66% of probabilistic analysis simulations and generated more QALYs in approximately 92% of simulations. An incremental cost-effectiveness ratio < $50,000 was found in 68% of simulations. Conclusions: The present study provides guidance regarding the cost-effectiveness of an integrated management approach compared with usual specialty care of AF in a Canadian setting. We recommend further study be undertaken that prospectively plans for economic evaluation before definitive assessments of cost-effectiveness can be made.
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