Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation.
AIMS
A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess cost-effectiveness of this nurse-led care programme vs. usual care.


METHODS AND RESULTS
A cost-effectiveness analysis was undertaken alongside the randomized controlled trial in which 712 patients were included at the Maastricht University Medical Centre, The Netherlands, and allocated to nurse-led care or usual care. Nurse-led care implied guideline-adherent management, steered by dedicated software, supervised by cardiologists. Usual care was regular outpatient care performed by cardiologists. A cost per life-year and a cost per quality-adjusted life-year (QALY) analysis was performed, both from a hospital perspective. The nurse-led care programme was associated with slightly more life-years and QALYs at a lower cost. Specifically, the nurse-led programme contributed to 0.009 QALY gains with a reduced cost of €1109 per patient and a gain of 0.02 life-years with a reduced cost of €735 per patient. Therefore, the nurse-led programme would be considered dominant. In fact, for all the possible values of willingness to pay for a QALY the nurse-led programme is considered to be more likely cost-effective than the care as usual.


CONCLUSION
The cost-effectiveness analysis in the present study demonstrated that a nurse-led integrated care approach will save costs and improve survival and quality of life, and is therefore a cost-effective management strategy for patients with AF.
['Hendriks|Jeroen|J|', 'Tomini|Florian|F|', 'van Asselt|Thea|T|', 'Crijns|Harry|H|', 'Vrijhoef|Hubertus|H|']
D000368:Aged D001281:Atrial Fibrillation D064646:Cardiovascular Nursing D003362:Cost-Benefit Analysis D019033:Delivery of Health Care, Integrated D005260:Female D017048:Health Care Costs D017052:Hospital Mortality D006801:Humans D008297:Male D009426:Netherlands D011788:Quality of Life D016019:Survival Analysis D015996:Survival Rate D016896:Treatment Outcome
Cost-effectiveness Atrial fibrillation Cardiovascular hospitalization and death Outpatient care Adherence to guidelines Nursing