Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

Jeroen Hendriks, Florian Tomini, Thea Van Asselt, Harry Crijns, Hubertus Vrijhoef

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

Abstract

AimsA 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 resultsA 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.ConclusionThe 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. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Pages (from-to)1128-1135
Number of pages8
JournalEUROPACE
Volume15
Issue number8
DOIs
Publication statusPublished - Aug 2013
Externally publishedYes

Keywords

  • Adherence to guidelines
  • Atrial fibrillation
  • Cardiovascular hospitalization and death
  • Cost-effectiveness
  • Nursing
  • Outpatient care

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